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Als Standardoperationen der Adipositaschirurgie gelten Magenbypass, Schlauchmagen, biliopankreatische Diversion mit Duodenal-Switch und Magenband. Die Techniken unterscheiden sich hinsichtlich Komplexitat, Komplikationen, Nachsorge und Ergebnissen erheblich. Die Verfahrenswahl erfolgt deshalb individualisiert durch ein Spezialistenteam. Die niedrige postoperative Letalitat ( 40 kg/m² oder > 35 kg/m² mit Sekundarmorbiditat nach ausgeschopfter oder bei nicht erfolgversprechender konservativer Therapie. Die Nachsorge sollte lebenslang den nutritiven Status uberwachen und Mikronahrstoffe supplementieren. Mehr als ¾ der Patienten erreicht einen langfristigen Ubergewichtsverlust (EWL) von mehr als 50 % mit einer hohen Rate an Voll- oder Teilremissionen der Sekundarkomplikationen. Die Langzeittodesrate kann durch die Adipositaschirurgie um ⅓ gesenkt werden.

Bei Lagerung, Zugang und Instrumentation unterscheidet sich die minimal-invasive Chirurgie (MIC) fundamental von der konventionell-offenen Chirurgie. Jeder dieser Aspekte ist mit einer eigenen, spezifischen Morbiditat assoziiert, wie z. B. Lagerungsschaden, Trokarverletzungen, Hyperkapnie und thermische Lasionen. Technologische Entwicklungen und zunehmende Erfahrung erklaren die Reduktion von MIC-assoziierten Komplikationen und das Meistern von besonderen Herausforderungen. Diese Fortschritte sind Voraussetzung fur die beeindruckende Ausbreitung dieser neuen Operationsform in der Chirurgie des Haufigen wie Cholezystektomie oder Hernienreparatur und in der Chirurgie des Speziellen wie bariatrische, onkologische oder Thoraxchirurgie. Die vorliegende Ubersichtsarbeit befasst sich mit den MIC-spezifischen und MIC-typischen Komplikationen.

In unserer Gesellschaft steigt die Zahl der adiposen Patienten an, die wegen schwerwiegender Folgeerkrankungen einen adipositaschirurgischen Eingriff benotigen. Trotz Standardisierung dieser Operationen konnen Komplikationen wie Stenosen und Ulzerationen nach Magenbypass (RYGB) und Schlauchmagen (SG) auftreten. Unter Einbeziehung der aktuellen Literatur mit randomisierten klinischen Studien, Reviews, Einzelfallberichten und Expertenmeinungen wird ein Komplikationsmanagement entwickelt und vorgestellt. Stenosen treten mit einer Haufigkeit von 0,1–3,9 % bei der SG und 3–27 % beim RYGB auf. Sie sind meist Folge einer fehlerhaften Operationstechnik oder Mikroinsuffizienz. Ulzerationen finden sich vor allem nach RYGB in 2–12 % der Falle. Ursachlich kommen Fremdkorperreaktionen, lokale Ischamien, peptische Lasionen und Mikroinsuffizienzen infrage. Das therapeutische Vorgehen hangt von der Lokalisation und Genese der Striktur ab. Endoskopische Interventionen fuhren bei Stenosen meist zum Erfolg. Selten ergibt sich hier eine Indikation zur operativen Revision. Auch Ulzerationen konnen in der Regel konservativ behandelt werden. Eine operative Intervention ergibt sich bei akuten Notfallen wie Perforation oder Blutung.

Hintergrund Die totale mesorektale Exzision (TME) entlang der viszeralen Faszie („holy plane“) ist die chirurgische Standardoperation fur das mittlere und tiefe Rektumkarzinom. Diese schichtorientierte Dissektion hat ein erhebliches Potenzial fur die Verletzung der viszeralen Faszie, nachweislich durch inadaquate Praparatequalitat, und der parietalen Faszie, nachweislich durch Storung der autonomen Nervenfunktion. Wir haben eine Operationstechnik entwickelt, bei der die autonomen Nerven als zusatzliche anatomische Leitstrukturen im kleinen Becken verwendet werden.

Background Peristomal skin lesions are frequent complications of ostomy; however, there is no generally accepted nomenclature and classification system. Objective An interdisciplinary German expert panel (GESS) composed of ten members, developed an innovative semiquantitative classification system for peristomal skin lesions for further stratification of ostomy therapy. This score is based on criteria which can be assessed by stomal therapists and treating physicians. Results The new peristomal skin lesion score grades three categories: lesion (L), status of ostomy (S) and disease (D). The L category describes the integrity of the skin as normal (L0), lesion with sustained integrity of skin (L1), integrity destroyed (L2) and local infection (L3). The S category rates the complexity of ostomy therapy as normal (S0), increased (S1) and high but not sufficiently effective (S2). The additional letters for categorization O. R. P. H. E. US describe anatomical pathologies of the stoma itself: ostomy stenosis (O), retraction (R), prolapse (P), hernia (H), edema (E) and unfavorable site (US). A systemic disorder is either absent (D0), irrelevant (D1) or relevant (D2). The LSD score is the basis for a management algorithm. Conclusion The LSD score is comprehensive, standardized and holistic. Its straightforward use by health professionals can improve the consistency of the description of skin lesions and enhance the quality of ostomy therapy.

Introduction: Negative Pressure Wound Therapy (NPWT) is widely used in the management of the open abdomen despite uncertainty regarding several aspects of usage. An expert panel was convened to develop evidence-based recommendations describing the use of NPWT in the open abdomen. Methods: A systematic review was carried out to investigate the efficacy of a range of Temporary Abdominal Closure methods including variants of NPWT. Evidence-based recommendations were developed by an International Expert Panel and graded according to the quality of supporting evidence. Results: Pooled results, in non-septic patients showed a 72% fascial closure rate following use of commercial NPWT kits in the open abdomen. This increased to 82% by the addition of a ‘dynamic’ closure method. Slightly lower rates were showed with use of Wittmann Patch (68%) and home-made NPWT (vac-pack) (58%). Patients with septic complications achieved a lower rate of fascial closure than non-septic patients but NPWT with dynamic closure remained the best option to achieve fascial closure. Mortality rates were consistent and seemed to be related to the underlying medical condition rather than being influenced by the choice of dressing, Treatment goals for open abdomen were defined prior to developing eleven specific evidence-based recommendations suitable for different stages and grades of open abdomen. Discussion and conclusion: The most efficient temporary abdominal closure techniques are NPWT kits with or without a dynamic closure procedure. Evidence-based recommendations will help to tailor its use in a complex treatment pathway for the individual patient.

Das klinische und wissenschaftliche Interesse an der minimalinvasiven Osophagusresektion („minimally invasive esophagectomy“, MIE) nimmt zu. Allerdings ist die Technik – insbesondere die der intrathorakalen Anastomose – nicht standardisiert. Haufig wird sie mithilfe der Minithorakotomie per Zirkularstapler hergestellt. Im vorliegenden Beitrag wird eine Methode prasentiert, die ganzlich auf die Thorakotomie verzichtet, indem der Stapler transhiatal in den Thorax gefuhrt wird. Die Operationsergebnisse werden an einem nichtselektionierten Krankengut untersucht. Der abdominelle Akt erfolgt laparoskopisch und der thorakale minimalinvasiv in Linksseitenlage des Patienten unter Einlungenbeatmung. Ausmas von Resektion und Zweifeldlymphadenektomie entsprechend der konventionellen Operation. Die kippbare Andruckplatte wird transoral in den Osophagusstumpf platziert. Das Praparat wird uber einen transrektalen Wechselschnitt im rechten Oberbauch geborgen. Der Zirkularstapler wird extravulnar in den Magenschlauch positioniert und handgefuhrt transabdominell transhiatal in den Thorax vorgeschoben; hier erfolgt die Anastomosierung videoendoskopisch. Die Krankenakten der konsekutiven Patientenserie wurden retrospektiv ausgewertet. Von Juni 2010 bis Juni 2013 wurden 23 Patienten (medianes Alter 69 Jahre; Range 46 bis 80 Jahre) mit Adeno- (n = 19) oder Plattenepithelkarzinomen (n = 4) total-minimalinvasiv operiert. Davon waren 15 Patienten neoadjuvant vorbehandelt (10 Teil- und 4 Vollremissionen). Alle Resektionen und intrathorakalen Anastomosen wurden ohne technische Schwierigkeiten/Konversion in 305 min (Range 220–441 min) durchgefuhrt. Die mediane Lymphknotenzahl betrug 16 (Range 4–42), die R0-Rate 91 %. Zwei Anastomoseninsuffizienzen konnten mit endoskopischen Techniken beherrscht werden. Kein Patient verstarb. Die intrathorakale Anastomose kann mit der vorgestellten Technik in standardisierter Weise total-minimalinvasiv auch ohne Thorakotomie hergestellt werden. Oberstes Ziel bleibt die Reduktion der Morbiditat.

Nach operativer Harnableitung uber ein Ileumconduit stellen parastomale Hernien mit einer Inzidenz von 4–16% eine relativ haufige Komplikation dar. Eine operative Korrektur wird nach allgemeinen Angaben in etwa 30–35% der Falle notwendig. Fur die operative Korrektur einer parastomalen Hernie sind verschiedenste Verfahren beschrieben worden. Die primare Fasziennaht hat eine hohe Rezidivrate von 46–100%, wohingegen die Stomaneuplatzierung mit Komplikationsraten von bis zu 88% assoziiert ist. Mit der Verwendung von alloplastischem Material (meist Polypropylennetze) kann die Rezidivrate deutlich von bis zu 100% fur die primare Fasziennaht und 71% fur die Stomatranslokation auf 33% gesenkt werden. Netze mit einer Doppelbeschichtung aus Polypropylen und ePTFE („expanded polytetrafluorethylene“), kombinieren die Vorteile der ausgepragten Bauchwandverstarkung durch einsprossendes Bindegewebe mit der einfachen, schonenden und gut kontrollierbaren intraperitonealen Platzierungsmoglichkeit. In der Arbeit werden unsere Erfahrungen mit doppelt beschichteten Zwei-Komponenten-Netzen zur Hernienversorgung nach Anlage eines Ileumconduits vorgestellt.

Minimally invasive surgery (MIS) is fundamentally different from open surgery regarding positioning of the patient, access routes and instrumentation. Each of these aspects is associated with its own specific morbidity, such as positioning-related complications, trocar-induced lesions, hypercapnia-associated phenomena and thermal damage. The growing experience of surgeons and technological progress have increased patient safety to a maximum and have resulted in an impressive spread of MIS in the various fields of surgery including the most common, such as cholecystectomy and hernia repair and special fields, such as bariatric, thoracic and oncological surgery. This narrative review summarizes the current knowledge on the inherent complications of MIS.

The increasing number of morbidly obese patients leads to a rising number of bariatric procedures in Germany. The operative techniques are highly standardized but such a standardization is lacking for the management of postoperative complications such as stenosis and ulceration after Roux-en-Y gastric bypass (RYGB) surgery and sleeve gastrectomy (SG).The current literature is reviewed and a complication management is developed and presented in this article.Postoperative stenoses occure with a frequency of 0.1-3.9% after SG and 3-27% after RYGB. Stenosis is secondary to inadequate surgical technique or microinsufficiency. Ulcers can be due to reaction to foreign body, local ischemia, peptic lesion, fistula and microinsufficiency.Endoscopic interventions are successful in most cases for stenosis after RYGB and for short stenoses after SG. After SG long stenoses require redo surgery and conversion to RYGB. Ulcers can be managed by medication with the exception of perforation and hemorrhage, which require emergency laparoscopy.

Peristomal skin lesions are frequent complications of ostomy; however, there is no generally accepted nomenclature and classification system.An interdisciplinary German expert panel (GESS) composed of ten members, developed an innovative semiquantitative classification system for peristomal skin lesions for further stratification of ostomy therapy. This score is based on criteria which can be assessed by stomal therapists and treating physicians.The new peristomal skin lesion score grades three categories: lesion (L), status of ostomy (S) and disease (D). The L category describes the integrity of the skin as normal (L0), lesion with sustained integrity of skin (L1), integrity destroyed (L2) and local infection (L3). The S category rates the complexity of ostomy therapy as normal (S0), increased (S1) and high but not sufficiently effective (S2). The additional letters for categorization O. R. P. H. E. US describe anatomical pathologies of the stoma itself: ostomy stenosis (O), retraction (R), prolapse (P), hernia (H), edema (E) and unfavorable site (US). A systemic disorder is either absent (D0), irrelevant (D1) or relevant (D2). The LSD score is the basis for a management algorithm.The LSD score is comprehensive, standardized and holistic. Its straightforward use by health professionals can improve the consistency of the description of skin lesions and enhance the quality of ostomy therapy.

The clinical and scientific interest in minimally invasive techniques for esophagectomy (MIE) are increasing; however, the intrathoracic esophagogastric anastomosis remains a surgical challenge and lacks standardization. Surgeons either transpose the anastomosis to the cervical region or perform hybrid thoracotomy for stapler access.This article reports technical details and early experiences with a completely laparoscopic-thoracoscopic approach for Ivor Lewis esophagectomy without additional thoracotomy.The extent of radical dissection follows clinical guidelines. Laparoscopy is performed with the patient in a beach chair position and thoracoscopy in a left lateral decubitus position using single lung ventilation. The anvil of the circular stapler is placed transorally into the esophageal stump. The specimen and gastric conduit are exteriorized through a subcostal rectus muscle split incision. The stapler body is placed into the gastric conduit and both are advanced through the abdominal mini-incision transhiatally into the right thoracic cavity, where the anastomosis is constructed. Data were collected prospectively and analyzed retrospectively.A total of 23 non-selected consecutive patients (mean age 69 years, range 46-80 years) with adenocarcinoma (n = 19) or squamous cell carcinoma (n = 4) were surgically treated between June 2010 and July 2013. Neoadjuvant therapy was performed in 15 patients resulting in 10 partial and 4 complete remissions. There were no technical complications and no conversions. Mean operative time was 305 min (range 220-441 min). The median lymph node count was 16 (range 4-42). An R0 resection was achieved in 91 % of patients and 3 anastomotic leaks occurred which were successfully managed endoscopically. There were no postoperative deaths.The intrathoracic esophagogastric anastomosis during minimally invasive Ivor Lewis esophagectomy can be constructed in a standardized fashion without an additional thoracotomy. Reduction of surgical morbidity remains the highest priority.

The German NOTES registry (GNR) was initiated by the German Society for General and Visceral Surgery (DGAV) as a treatment and outcome database for natural orifice transluminal endoscopic surgery (NOTES).The aim of this study was the descriptive analysis of all GNR data collected over a 5-year period since its start in 2008 with more than 3000 interventions.The GNR is an online database with voluntary participation available to all German-speaking clinics. Demographic data, therapy details, complications and data on the postoperative course of patients are recorded. All cases in the GNR between March 2008 and November 2013 were included in the analysis.From a total of 3150 data sets 2992 (95 %) were valid and suited for the analysis. Hybrid transvaginal cholecystectomy was the most frequently used procedure (88.7 %), followed by hybrid transvaginal/transgastric appendectomy (6.1 %) and hybrid transvaginal/transrectal colon procedures (5.1 %). Intraoperative complications occurred in 1.6 %, postoperative complications in 3.7 % and conversions were reported in 1.5 %. Intraoperative bladder injuries and postoperative urinary tract infections were identified as method-specific complications of transvaginal procedures. Bowel injuries occurred as a rare (0.2 %) but potentially serious complication of transvaginal operations.The German surgical community ensures a safe and responsible introduction of the new NOTES operation techniques with its active participation in the GNR. Despite an overall low complication rate, the high number of procedures in the GNR permitted the identification of method-specific complications. This knowledge can be used to further increase the safety of NOTES in practice.

Summary Background: Anal cancer is an evolving problem in HIV-infected patients. In fear of excessive toxicity in patients with HIV infection, aggress

Metastatic calcinosis is a common feature of chronic renal failure. Its first manifestations are bone demineralization and non-visceral and/or visceral calcification with mostly mural deposits in arteries and arterioles. It is initially characterized by hyperphosphataemia followed by secondary or tertiary hyperparathyroidism. Cutaneous involvement is a rare complication. Histologically, the lesions show vascular calcification with ischaemic skin necrosis. Extreme cases may produce calcinosis cutis (calciphylaxis), i.e. disseminated calcification of the subcutaneous tissue and dermis in the form of hard painful cutaneous nodules and plaques with subsequent ulceration. Metastatic calcinosis is a disease affecting adults, while the dystrophic or idiopathic type can develop in children. We present the case of a 6-year-old boy with end-stage renal disease, attributed to congenital renal hypoplasia, and accompanied by secondary hyperparathyroidism. He developed fulminant tertiary hyperparathyroidism and metastatic calcinosis of the lungs, as well as cutaneous necrosis of the buttocks and legs, subsequent to calcification of arteries and arterioles. A maternal renal transplant failed to function. The serum parathormone, calcium and phosphate levels could not be controlled by maintenance dialysis, phosphate binders and calcitriol. Total parathyroidectomy without autotransplantation of parathyroid tissue rapidly returned the serum parathormone, calcium and phosphate levels to normal. In addition, topical treatment using merbromine solution and hydrocolloid dressings, healed the ulcers with significant scar formation, within 2.5 months after parathyroidectomy. A renewed increase of the calcium x phosphate product, 2 months after parathyroidectomy, was attributed to mobilization of calcium compounds from the viscera, as confirmed by a chest X-ray.

The incidence of parastomal hernia in ileal conduit urinary diversion ranges from 4% to 16%. Surgical correction is necessary in about one third of cases and different techniques of surgical reconstruction have been described. Primary fascial repair has a high recurrence rate of 46-100% whereas stoma translocation is associated with complication rates of up to 88%. The use of alloplastic material (usually polypropylene meshes) has reduced the recurrence rate by up to 100% for primary fascial repair and 71% for stoma translocation down to 33%.Composite meshes consist of two layers, a polypropylene layer and an expanded polytetrafluoroethylene (ePTFE) layer. The former is placed against the abdominal wall for permanent reinforcement by ingrowing connective tissue and the ePTFE layer is placed against the abdominal organs preventing adhesions with the bowel. The intraperitoneal placement of such composite meshes is a standardized, simplified, gentle and controllable surgical procedure. This article reports experiences with the surgical correction of parastomal hernias in ileal conduits using composite meshes.

Negative pressure wound therapy (NPWT) has become widely adopted over the last 15 years and over 1000 peer reviewed publications are available describing its use. Despite this, there remains uncertainty regarding several aspects of usage. In order to respond to this gap a global expert panel was convened to develop evidence-based recommendations describing the use of NPWT. In this paper the results of the study of evidence in traumatic wounds (including soft tissue defects, open fractures and burns) and reconstructive procedures (including flaps and grafts) are reported. Evidence-based recommendations were obtained by a systematic review of the literature, grading of evidence, drafting of the recommendations by a global expert panel, followed by a formal consultative consensus development program in which 422 independent healthcare professionals were able to agree or disagree with the recommendations. The criteria for agreement were set at 80% approval. Evidence and recommendations were graded according to the SIGN (Scottish Intercollegiate Guidelines Network) classification system. Twelve recommendations were developed in total; 4 for soft tissue trauma and open fracture injuries, 1 for burn injuries, 3 for flaps and 4 for skin grafts. The present evidence base is strongest for the use of NPWT on skin grafts and weakest as a primary treatment for burns. In the consultative process, 11/12 of the proposed recommendations reached the 80% agreement threshold. The development of evidence-based recommendations for NPWT with direct validation from a large group of practicing clinicians offers a broader basis for consensus than work by an expert panel alone.

The hydrogen clearance technique (HCT) was employed for measurements of local pancreatic blood flow (PBF) in dogs, opossums, and rats under normal conditions and in opossums during biliary pancreatitis. Local PBF (ml/min/100 g) in dogs was 57.6 +/- 10.4, in opossums 60.6 +/- 9.5, and in rats 144.7 +/- 23.4, under resting conditions. Regional distribution of local PBF in dogs showed no statistical differences. Technical aspects of the HCT were described in detail. Under physiological conditions parenchymal trauma following electrode implantation was negligible in nearly all cases. More than 95% of registered clearance curves were monoexponential and showed excellent reproducibility of PBF values in repeated measurements (percentage deviationor = 6.7). Five days after initiating biliary pancreatitis by common channel ligation in opossums local PBF was 72.1 +/- 14.7 after implantation of new electrodes. Chronically implanted electrodes, however, recorded only 39.7 +/- 15.8, due to massive fibro-proliferative alterations around the implanted electrode tips. We therefore conclude that the HCT as described is a useful tool for measuring local PBF in acute experimental settings only. Biliary pancreatitis in our model causes no significant alterations of PBF after 5 days.

The role of myoneural continuity between the sphincter of Oddi and duodenum in coordinating sphincter cyclic motility and the duodenal migrating myoelectric complex was studied in conscious opossums. Five animals underwent implantation of the duodenal papilla into the jejunum. Myoelectric recording was obtained from the sphincter, duodenum, and jejunum in these animals and from 5 other animals as controls. The mean spike frequency of the sphincter of controls was 1.6 per min during phase I, 4.2 per min during phase II, 11.0 per min during phase III, and 3.6 per min during phase IV of the duodenal migrating myoelectric complex. After translocation of the papilla, the spike rates during phase II (2.2 per min) and phase III (2.8 per min) were lower than in controls (p

Introduction: Major surgery is often followed by an overwhelming systemic inflammatory response syndome (SIRS) which is considered to be the major cause of multiorgan dysfunction syndrome (MODS). The »ntestine-sepsis-hypothesis« considers the breakdown of the intestinal barrier followed by bacterial translocation a major step towards the development of SIRS. The present clinical study prospectively investigates the relation of intestinal barrier dysfunction and the risc of multiorgan failure (MOF) after major abdominal and vascular surgery. Materials and methods: 36 patients (68 ± 20 years; m : w 20 : 16) after major elective abdominal and vascular operations (esophagectomies (3), colorectal resections (18), aortic aneurysm operations (15)) were included into this study. Preoperatively and 24, 72 and 120 hours after operation clinical data as well as laboratory exams were performed. Concentrations after oral application of sugar (15 g lactulose; 0.5 g mannitol, 2.0 g rhamnose, 1.0 g xylose) were determined in urine of patients (HPLC). The clinical course was estimated by APACHE II score, MOF was evaluated by Goris-score. Results: According to APACHE II (≥ 10 points) and MOF-score (≥ 5 points) patients with bad prognosis (multiorgan failure, group 1; n = 10) and patients with good prognosis (group 2; n = 26) were differentiated. After enteral application of mono- and disaccharids an increased intestinal permeability measured by mannitol excretion into urine was found 24 hours(significant, p < 0.05 Mann-Whitney U-test, MOF vs. group2: 4.46 ± 1.20 vs. 0.89 ± 0.23) and 72 hours (significant, p < 0.05 MOF vs. group2: 0.88 ± 0.29 vs. 0.24 ± 0.03) postoperatively in the MOF group. This difference was not found 120 hours postoperatively. Mannitol concentration correlated with MOF-score and after 72 hours even with survival probability. Lactulose/rhamnose ratio also showed the tendency of increasing intestinal permeability in the multiorgan failure group, however without significance. ROC-Analysis showed that intestinal permeability 72 hours postoperatively is predictive for survival of patients after extended abdominal and vascular operations. Conclusion: Our results confirm that patients with a multiorgan failure show an increased intestinal permeability in the early phase after large visceral surgery. These observations are consistent with the »ntestine-sepsis-hypothesis« and indicate an important role of intestinal barrier disturbances in the development of MOF after extended abdominal surgery.

This study tested the hypothesis that EGF has a protective effect on the intestinal barrier function in experimental TNBS-induced colitis. EGF was given intraperitoneally one hour before and 24 hours after induction of colitis. The rats were killed 48 hours after induction of colitis: The distal colon was resected and mounted into Ussing chambers. Flux measurements were performed for Na+ and mannitol, and epithelial and subepithelial resistances were determined. A semiquantitative histological score was used to grade acute and chronic inflammation. Compared to controls, TNBS caused a 3-fold increase in both fluxy, indicating enhanced paracellular permeability. There rates was a severe reduction of total and epithelial resistances indicating a dramatic defect of epithelial barrier function. EGF failed to improve the electrophysiologic and histologic parameters. Therefore, EFG has no protective effective in experimental TNBS colitis.

The aim of this study was to analyze the effect of enterally given zinc on the impaired epithelial barrier function in experimental TNBS colitis in rats. Rats in therapy group were zinc-fed in therapeutic dose. 48 hours after induction of TNBS colitis the rats were killed, the distal colon was resected and mounted into an Ussing chamber. The following electrophysiological measurements were carried out: 1. Flux measurements for Na+ and mannitol as a parameter of paracellular permeability, 2. Resistance measurements of the colon, distinguishing between pure epithelial resistance and resistance of the subepithelial tissue. In TNBS colitis we found a marked increase of both fluxes as a parameter of enhanced paracellular permeability (factor 3). Further there was a drastic reduction of total resistance, and especially of pure epithelial resistance indicating a massive epithelial barrier defect. In rats treated by zinc the increase of paracellular permeability was increased only by a factor of 2, and there was only a moderate decrease of resistance. For the first time we demonstrated zinc to have a protective effect on damaged mucosal barrier function in TNBS colitis. These results confirm the data collected in guinea pigs with malnutrition, whose intestinal integrity could be improved by zinc. Further studies are necessary in order to test whether this protective effect of zinc on mucosa barrier in experimental colitis may be relevant also in human ulcerative colitis.

The influence of experimental pancreatitis on bowel motility was measured in vivo with the propulsion technique and in vitro as contractility of isolated ileum muscle strips. In edematous pancreatitis, propulsion was reduced but contractility was normal. Both, propulsion and contractility were reduced in necrotizing pancreatitis. The intravenous saline infusion normalized propulsion in edematous pancreatitis but was of no benefit in necrotising pancreatitis. These results indicate that extraintestinal (neuroendocrine) regulation pathways were effected in edematous pancreatitis. Necrotising pancreatitis appears to have an additional profound influence on the intrinsic, intramural regulation of motility.

The aim of the present study was to determine the changes in permeability and mucosal function after ileo-pouchanal anastomosis (IPAA) in patients with ulcerative colitis. We examined 24 patients (m: f = 15:9; Age = 35.2 +/- 12.5) prior to colectomy (pre IPAA), prior to closure of ileostomy (pre CIS), after closure of ileostomy (post CIS), in case of pouchitis and 5 controls. With a miniaturizised Ussing-chamber electrophysiological parameters of permeability and resorptive isotope-fluxes for mannitol were measured. Total resistance could be differenciated into epithelial and subepithelial resistance by using alternating current impedance measurements. Active Na(+)-glucose-Cotransport was measured by detection of the maximal short-curcuit-current under stepwise addition of glucose and active Cl(-)-secretion was measured by the increase in short-curcuit-current after stimulation with Theophillin and PGE2. Epithelial resistance of pouchitis was slightly raised towards controls but did not differ from the others. Subepithelial resistance post CIS and pouchitis was significantly increased versus controls and pre CIS (21.2 +/- 22.4 vs. 10.7 +/- 13.3 omega cm2) Whereas Cl-secretion of pouchitis was significantly reduced vs. post CIS and controls (38.6 vs. 120.9 +/- 113.9 microA cm-2). In the same way Na(+)-glucose Cotransport of pouchitis was significantly reduced vs. post CIS and controls(41.8 vs. 138.4 +/- 264.4 microA cm-2). Increasing subepithelial resistance post CIS and in pouchitis is a hint for an adaptive thickening of the subepitheal layer. Concerning the functional analysis pouchitis and terminal ileum prior to IPAA show a reduced secretion and resorption whereas the mucosal barrier towards Mannitol remains unchanged.

Reduced intestinal motility and bacterial translocation are associated with septic complications and increased mortality in acute necrotizing pancreatitis (ANP). This study demonstrates that administration of nitric oxide (NO) donors further reduces intestinal motility and enhances severity of ANP. In contrast intestinal motility is restored to almost normal levels by inhibition of NO-synthase. Selective inhibition of iNO-synthase by SMT proved to be most effective. These results suggest that septic complications in ANP may be reduced by SMT treatment.