Controversial opinions exist concerning the effect of laparoscopic adjustable gastric banding on gastroesophageal reflux. MEDLINE and EMBASE databases were searched for relevant studies on patients undergoing adjustable gastric banding. Data are expressed in mean (range). Twenty studies were identified with a total of 3307 patients. The prevalence of reflux symptoms decreased postoperatively from 32.9% (16[ndash]57) to 7.7% (0[ndash]26.9) and medication use from 27.5% (16[ndash]38.5) to 9.5% (3.1[ndash]19.2). Newly developed reflux symptoms were found in 15% (6.1[ndash]20) of the patients. The percentage of esophagitis decreased postoperatively from 33.3% (19.4[ndash]61.6) to 27% (2.3[ndash]60.8). Newly developed esophagitis was observed in 22.9% (0[ndash]38.4). Pathological reflux was found in 55.8% (34.9[ndash]77.4) preoperatively and postoperatively in 29.4% (0[ndash]41.7) of the patients. Lower esophageal sphincter pressures increased from 12.9 to 16.9 mmHg (11.3[ndash]21.4). Lower esophageal sphincter relaxation decreased from 100% to 79.7% (58[ndash]86). The percentage of dysmotility increased from 3.5% (0[ndash]10) to 12.6% (0[ndash]25). Adjustable gastric banding has anti-reflux properties resulting in resolution or improvement of reflux symptoms, normalized pH monitoring results and a decrease of esophagitis on short term. However, worsening or newly developed reflux symptoms and esophagitis are found in a subset of patients during longer follow-up. (Source: Obesity Reviews) MedWorm Message: Get the very latest Swine Flu news via the MedWorm Swine Flu RSS news feed - updated hourly from thousands of authoritative health and news sources.

Abstract Background  Morbid obesity is associated with gastroesophageal reflux (GERD). The aim of this prospective study was to determine esophageal motility in asymptomatic morbidly obese patients and compare it to non-obese individuals. Methods  Forty-seven morbidly obese patients without GERD symptoms and 15 normal weight individuals were divided into four groups according to their body mass index (BMI; group I,  40 kg/m2) have a dysfunction of the LES and an altered esophageal motility, even when they are asymptomatic for GERD symptoms. Content Type Journal ArticleCategory ResearchDOI 10.1007/s11695-009-9881-zAuthors M. A. Küper, University of Tübingen Department of General, Visceral, and Transplant Surgery Hoppe-Seyler-Straße 3 72076 Tübingen GermanyK. M. Kramer, University of Tübingen Department of General, Visceral, and Transplant Surgery Hoppe-Seyler-Straße 3 72076 Tübingen GermanyA. Kischniak, Hospital Neuwerk Department of General, Visceral and Minimally Invasive Surgery Mönchengladbach GermanyM. Zdichavsky, University of Tübingen Department of General, Visceral, and Transplant Surgery Hoppe-Seyler-Straße 3 72076 Tübingen GermanyJ. H. Schneider, University of Tübingen Department of General, Visceral, and Transplant Surgery Hoppe-Seyler-Straße 3 72076 Tübingen GermanyD. Stüker, University of Tübingen Department of General, Visceral, and Transplant Surgery Hoppe-Seyler-Straße 3 72076 Tübingen GermanyT. Kratt, University of Tübingen Department of General, Visceral, and Transplant Surgery Hoppe-Seyler-Straße 3 72076 Tübingen GermanyA. Königsrainer, University of Tübingen Department of General, Visceral, and Transplant Surgery Hoppe-Seyler-Straße 3 72076 Tübingen GermanyF. A. Granderath, Hospital Neuwerk Department of General, Visceral and Minimally Invasive Surgery Mönchengladbach Germany Journal Obesity SurgeryOnline ISSN 1708-0428Print ISSN 0960-8923 (Source: Obesity Surgery)

Abstract Background  Oesophageal achalasia is a rare disorder in childhood. Common treatments in adults include oesophageal cardiomyotomy (laparoscopic or open) with fundoplication. We aimed to assess the results of laparoscopic oesophageal cardiomyotomy without fundoplication for treatment of achalasia in children. Methods  We reviewed the results of laparoscopic oesophageal cardiomyotomy between January 1998 and June 2008. Patients below the age of 18 years, who had undergone laparoscopic oesophageal cardiomyotomy without an anti-reflux procedure by a single surgeon, were identified. Data were collected from patient notes. Results are reported as median (range). Results  There were 20 patients (13 males and 7 females). Median age at surgery was 12 years (5–15 years) and weight was 38 kg (15–53 kg). Median duration of symptoms before surgery was 2.4 years (1.5–5 years). Duration of surgery was 96 min (60–160 min). Four patients (20%) required conversion to the open technique. In the remaining 16 children, fluids were started at a median of 7 h (6–8 h) post-operatively, and solid feeds were commenced at 22 h (20–24 h). Median length of hospital stay was 3 days (1–5 days). Median length of follow-up was 60 months (8–114 months). None of the patients had evidence of gastro-oesophageal reflux post-operatively. Five patients (25%) continued to experience dysphagia, with one of them also experiencing vomiting. Two patients were found to have oesophageal stricture and three patients were found to have oesophageal dysmotility. The remaining patients are asymptomatic. Conclusions  These results suggest that laparoscopic oesophageal cardiomyotomy is a valid treatment in children with achalasia. In our experience, an adjunctive anti-reflux procedure is not required, as there was no evidence of post-operative gastro-oesophageal reflux in all patients. Oesophageal stricture and dysmotility account for residual post-operative symptoms. Content Type Journal ArticleDOI 10.1007/s00464-009-0513-4Authors Larisa Corda, Chelsea and Westminster Hospital NHS Foundation Trust Department of Paediatric Surgery 369 Fulham Road London SW9-10NH UKMaurizio Pacilli, Chelsea and Westminster Hospital NHS Foundation Trust Department of Paediatric Surgery 369 Fulham Road London SW9-10NH UKSimon Clarke, Chelsea and Westminster Hospital NHS Foundation Trust Department of Paediatric Surgery 369 Fulham Road London SW9-10NH UKJohn M. Fell, Chelsea and Westminster Hospital NHS Foundation Trust Gastroenterology Unit London UKDavid Rawat, Chelsea and Westminster Hospital NHS Foundation Trust Gastroenterology Unit London UKMunther Haddad, Chelsea and Westminster Hospital NHS Foundation Trust Department of Paediatric Surgery 369 Fulham Road London SW9-10NH UK Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794 (Source: Surgical Endoscopy)

Digestion 2009;80:58-63 (DOI:10.1159/000215389) (Source: Digestion)

Motility and functional disorders of the small intestine, the colon and the anorectum can induce or contribute to symptoms such as diarrhoea, constipation and abdominal pain and may impair nutrient absorption in severe cases. Acute affections of intestinal functions e.g. during gastrointestinal infections usually need no functional diagnostics but resolve spontaneously or with adequate therapy of the underlying disease. By contrast, chronic disturbances of small intestinal, colonic and anorectal motility and/or sensitivity are subject to gastrointestinal function tests. The role of these tests for diagnosis and therapeutic handling of severe intestinal dysmotility/chronic intestinal pseudo-obstruction, severe constipation, diarrhoea, fecal incontinence and irritable bowel syndrome will be discussed in this review that mainly focuses on adults. (Source: Best Practice & Research. Clinical Gastroenterology)

Related Articles Ghrelin in patients with irritable bowel syndrome. Int J Mol Med. 2009 Jun;23(6):703-7 Authors: El-Salhy M, Lillebø E, Reinemo A, Salmelid L General gastrointestinal dysmotility occurs in patients with irritable bowel syndrome (IBS). Ghrelin seems to play an important role in regulating gastrointestinal motility. The present study was undertaken, therefore, to establish the possible role of ghrelin in the pathophysiology of IBS. Thirty-seven patients with IBS (19 had IBS-constipation and 18 IBS-diarrhoea) were included in this study. Ten healthy volunteers served as controls. After overnight fast, blood samples were drawn from patients and controls, and a gastroduodenal endoscopy was performed. Biopsies were taken from oxyntic mucosa and duodenum. Ghrelin cell density was determined by computer image analysis after immunohistochemical staining of the tissues. Total and active ghrelin were detected in tissue extracts and plasma by commercially available RIA and ELISA Kits. The density of ghrelin-immunoreactive cells in the oxyntic mucosa was significantly lower in IBS-constipation and significantly higher in IBS-diarrhoea patients than healthy controls (P PMID: 19424595 [PubMed - in process] (Source: International Journal of Molecular Medicine) MedWorm Message: Get the very latest Swine Flu news via the MedWorm Swine Flu RSS news feed - updated hourly from thousands of authoritative health and news sources.

Abstract Background  A periodic electrical activity, termed “slow waves”, coordinates gastrointestinal contractions. Slow-wave dysrhythmias are thought to contribute to dysmotility syndromes such as postoperative gastroparesis, but the clinical significance of these dysrhythmias remains poorly defined. Electrogastrography (EGG) has been unable to characterize dsyrhythmic activity reliably, and the most accurate method for evaluating slow waves is to record directly from the surface of the target organ. This study presents a novel laparoscopic device for recording serosal slow-wave activity, together with its validation. Methods  The novel device consists of a shaft (diameter, 4 mm; length, 300 mm) and a flexible connecting cable. It contains four individual electrodes and is fully shielded. Validation was performed by comparing slow-wave recordings from the laparoscopic device with those from a standard electrode platform in an open-abdomen porcine model. An intraoperative human trial of the device also was performed by recording activity from the gastric antrum of a patient undergoing a laparoscopic cholecystectomy. Results  Slow-wave amplitudes were similar between the laparoscopic device and the standard recording platform (mean 0.38 ± 0.03 mV vs range 0.36–0.38 ± 0.03 mV) (p = 0.94). The signal-to-noise ratio (SNR) also was similar between the two types of electrodes (13.7 dB vs 12.6 dB). High-quality antral slow-wave recordings were achieved in the intraoperative human trial (amplitude, 0.41 ± 0.04 mV; SNR, 12.6 dB), and an activation map was constructed showing normal aboral slow-wave propagation at a velocity of 6.3 ± 0.9 mm/s. Conclusions  The novel laparoscopic device achieves high-quality serosal slow-wave recordings. It is easily deployable and atraumatic. It is anticipated that this device will aid in the clinical investigation of normal and dsyrhythmic slow-wave activity. In particular, it offers new potential for investigating the effect of surgical procedures on slow-wave activity. Content Type Journal ArticleCategory New TechnologyDOI 10.1007/s00464-009-0515-2Authors Gregory O’Grady, The University of Auckland Department of Surgery Private Bag 92019 Auckland 1142 New ZealandPeng Du, The University of Auckland Auckland Bioengineering Institute Private Bag 92019 Auckland 1142 New ZealandJohn U. Egbuji, The University of Auckland Department of Surgery Private Bag 92019 Auckland 1142 New ZealandWim J. E. P. Lammers, The University of Auckland Auckland Bioengineering Institute Private Bag 92019 Auckland 1142 New ZealandAthiq Wahab, Al Ain University Department of Physiology Al Ain United Arab EmiratesAndrew J. Pullan, The University of Auckland Auckland Bioengineering Institute Private Bag 92019 Auckland 1142 New ZealandLeo K. Cheng, The University of Auckland Auckland Bioengineering Institute Private Bag 92019 Auckland 1142 New ZealandJohn A. Windsor, The University of Auckland Department of Surgery Private Bag 92019 Auckland 1142 New Zealand Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794 (Source: Surgical Endoscopy)

Conclusions  The novel laparoscopic device achieves high-quality serosal slow-wave recordings. It is easily deployable and atraumatic. It is anticipated that this device will aid in the clinical investigation of normal and dsyrhythmic slow-wave activity. In particular, it offers new potential for investigating the effect of surgical procedures on slow-wave activity. Content Type Journal ArticleCategory New TechnologyDOI 10.1007/s00464-009-0515-2Authors Gregory O’Grady, The University of Auckland Department of Surgery Private Bag 92019 Auckland 1142 New ZealandPeng Du, The University of Auckland Auckland Bioengineering Institute Private Bag 92019 Auckland 1142 New ZealandJohn U. Egbuji, The University of Auckland Department of Surgery Private Bag 92019 Auckland 1142 N... MedWorm Message: Get the very latest Swine Flu news via the MedWorm Swine Flu RSS news feed - updated hourly from thousands of authoritative health and news sources.

Conclusions  The novel laparoscopic device achieves high-quality serosal slow-wave recordings. It is easily deployable and atraumatic. It is anticipated that this device will aid in the clinical investigation of normal and dsyrhythmic slow-wave activity. In particular, it offers new potential for investigating the effect of surgical procedures on slow-wave activity. Content Type Journal ArticleCategory New TechnologyDOI 10.1007/s00464-009-0515-2Authors Gregory O’Grady, The University of Auckland Department of Surgery Private Bag 92019 Auckland 1142 New ZealandPeng Du, The University of Auckland Auckland Bioengineering Institute Private Bag 92019 Auckland 1142 New ZealandJohn U. Egbuji, The University of Auckland Department of Surgery Private Bag 92019 Auckland 1142 N... MedWorm Message: Get the very latest Swine Flu news via the MedWorm Swine Flu RSS news feed - updated hourly from thousands of authoritative health and news sources.

Conclusions  The novel laparoscopic device achieves high-quality serosal slow-wave recordings. It is easily deployable and atraumatic. It is anticipated that this device will aid in the clinical investigation of normal and dsyrhythmic slow-wave activity. In particular, it offers new potential for investigating the effect of surgical procedures on slow-wave activity. Content Type Journal ArticleCategory New TechnologyDOI 10.1007/s00464-009-0515-2Authors Gregory O’Grady, The University of Auckland Department of Surgery Private Bag 92019 Auckland 1142 New ZealandPeng Du, The University of Auckland Auckland Bioengineering Institute Private Bag 92019 Auckland 1142 New ZealandJohn U. Egbuji, The University of Auckland Department of Surgery Private Bag 92019 Auckland 1142 N... MedWorm Message: Get the very latest Swine Flu news via the MedWorm Swine Flu RSS news feed - updated hourly from thousands of authoritative health and news sources.

Conclusions  These results suggest that BM contains cells that may incorporate into ICC networks and improve dysmotility in W/W v mice. Thus, BM transplantation may become to a new therapeutic modality for gut dysmotilities due to ICC insufficiency. Content Type Journal ArticleCategory Original Article—Alimentary TractDOI 10.1007/s00535-009-0077-zAuthors Shuji Ishii, Osaka University Graduate School of Medicine Department of Gastroenterology and Hepatology (K1) 2-2 Yamadaoka Suita Osaka 565-0871 JapanShingo Tsuji, Osaka University Graduate School of Medicine Department of Gastroenterology and Hepatology (K1) 2-2 Yamadaoka Suita Osaka 565-0871 JapanMasahiko Tsujii, Osaka University Graduate School of Medicine Department of Gastroenterology and Hepatology (K1) 2-2 Ya...

Abstract Purpose  Interstitial cells of Cajal (ICC) play important roles in autonomic gut motility as electrical pacemakers and mediators of neural regulation of smooth muscle functions. Insufficiency of ICC has been reported in a wide range of gut dysmotilities. Thus, restoration of ICC may be a therapeutic modality in these diseases. Here we provide evidence that transplanted bone marrow (BM) cells can restore gut dysmotility in part via transdifferentiation to ICC. Methods  Bone marrow cells obtained from Kit insufficient W/W v mice or syngeneic GFP-transgenic mice with wild-type Kit were transferred to W/W v recipients. Whole gut transit time and gastric emptying were examined 5 and 6 weeks after BM transplantation, respectively, and ICCs were identified in whole mounts, frozen sections and transmission electron immunomicroscopy of the gut smooth muscle layers using specific antibodies. Results  Transplantation of wild-type BM into W/W v mice significantly improved whole gut transit time and gastric emptying. Fluorescent immunohistochemistry revealed GFP+Kit+ cells in the myenteric plexus, deep muscular plexus, and submucosal plexus smooth muscle layers of the stomach, small intestine, and colon, respectively. In the whole mounts, GFP+Kit+ cells were bipolar and spindle shaped, and transmission electron immunomicroscopy showed GFP+ cells rich in mitochondria and endoplasmic reticulum between gut smooth muscle layers, suggesting the presence of GFP+ cells with morphological characteristics of ICC. Conclusions  These results suggest that BM contains cells that may incorporate into ICC networks and improve dysmotility in W/W v mice. Thus, BM transplantation may become to a new therapeutic modality for gut dysmotilities due to ICC insufficiency. Content Type Journal ArticleCategory Original Article—Alimentary TractDOI 10.1007/s00535-009-0077-zAuthors Shuji Ishii, Osaka University Graduate School of Medicine Department of Gastroenterology and Hepatology (K1) 2-2 Yamadaoka Suita Osaka 565-0871 JapanShingo Tsuji, Osaka University Graduate School of Medicine Department of Gastroenterology and Hepatology (K1) 2-2 Yamadaoka Suita Osaka 565-0871 JapanMasahiko Tsujii, Osaka University Graduate School of Medicine Department of Gastroenterology and Hepatology (K1) 2-2 Yamadaoka Suita Osaka 565-0871 JapanTsutomu Nishida, Osaka University Graduate School of Medicine Department of Gastroenterology and Hepatology (K1) 2-2 Yamadaoka Suita Osaka 565-0871 JapanKenji Watabe, Osaka University Graduate School of Medicine Department of Gastroenterology and Hepatology (K1) 2-2 Yamadaoka Suita Osaka 565-0871 JapanHideki Iijima, Osaka University Graduate School of Medicine Department of Gastroenterology and Hepatology (K1) 2-2 Yamadaoka Suita Osaka 565-0871 JapanTetsuo Takehara, Osaka University Graduate School of Medicine Department of Gastroenterology and Hepatology (K1) 2-2 Yamadaoka Suita Osaka 565-0871 JapanSunao Kawano, Osaka University Graduate School of Medicine Department of Clinical Laboratory Science 2-2 Yamadaoka Suita Osaka 565-0871 JapanNorio Hayashi, Osaka University Graduate School of Medicine Department of Gastroenterology and Hepatology (K1) 2-2 Yamadaoka Suita Osaka 565-0871 Japan Journal Journal of GastroenterologyOnline ISSN 1435-5922Print ISSN 0944-1174 (Source: Journal of Gastroenterology)

Conclusions  These results suggest that BM contains cells that may incorporate into ICC networks and improve dysmotility in W/W v mice. Thus, BM transplantation may become to a new therapeutic modality for gut dysmotilities due to ICC insufficiency. Content Type Journal ArticleCategory Original Article—Alimentary TractDOI 10.1007/s00535-009-0077-zAuthors Shuji Ishii, Osaka University Graduate School of Medicine Department of Gastroenterology and Hepatology (K1) 2-2 Yamadaoka Suita Osaka 565-0871 JapanShingo Tsuji, Osaka University Graduate School of Medicine Department of Gastroenterology and Hepatology (K1) 2-2 Yamadaoka Suita Osaka 565-0871 JapanMasahiko Tsujii, Osaka University Graduate School of Medicine Department of Gastroenterology and Hepatology (K1) 2-2 Ya...

Conclusions  These results suggest that BM contains cells that may incorporate into ICC networks and improve dysmotility in W/W v mice. Thus, BM transplantation may become to a new therapeutic modality for gut dysmotilities due to ICC insufficiency. Content Type Journal ArticleCategory Original Article—Alimentary TractDOI 10.1007/s00535-009-0077-zAuthors Shuji Ishii, Osaka University Graduate School of Medicine Department of Gastroenterology and Hepatology (K1) 2-2 Yamadaoka Suita Osaka 565-0871 JapanShingo Tsuji, Osaka University Graduate School of Medicine Department of Gastroenterology and Hepatology (K1) 2-2 Yamadaoka Suita Osaka 565-0871 JapanMasahiko Tsujii, Osaka University Graduate School of Medicine Department of Gastroenterology and Hepatology (K1) 2-2 Ya...

Conclusions: In this mouse model of food allergy, we demonstrated a decreased response to a muscarinic agonist, and increased levels of proinflammatory IL-6 and Th2-related IL-4, but not Th1-related IFN-gamma mRNAs in jejunum. IgE levels in serum correlated with the number of jejunal MMCP-1+ cells, and predicted diarrhoea. Overall, these changes may reflect a protective mechanism of the gut in food allergy. (Source: BMC Gastroenterology)

Conclusions: In this mouse model of food allergy, we demonstrated a decreased response to a muscarinic agonist, and increased levels of proinflammatory IL-6 and Th2-related IL-4, but not Th1-related IFN-gamma mRNAs in jejunum. IgE levels in serum correlated with the number of jejunal MMCP-1+ cells, and predicted diarrhoea. Overall, these changes may reflect a protective mechanism of the gut in food allergy. (Source: BMC Gastroenterology)

Conclusions: In this mouse model of food allergy, we demonstrated a decreased response to a muscarinic agonist, and increased levels of proinflammatory IL-6 and Th2-related IL-4, but not Th1-related IFN-gamma mRNAs in jejunum. IgE levels in serum correlated with the number of jejunal MMCP-1+ cells, and predicted diarrhoea. Overall, these changes may reflect a protective mechanism of the gut in food allergy. (Source: BMC Gastroenterology)

Background: We hypothesized that food allergy causes a state of non-specific jejunal dysmotility. This was tested in a mouse model. Methods: Balb/c mice were epicutaneously sensitized with ovalbumin and challenged with 10 intragastric ovalbumin administrations every second day. Smooth muscle contractility of isolated circular jejunal sections was studied in organ bath with increasing concentrations of carbamylcholine chloride (carbachol). Smooth muscle layer thickness and mast cell protease-1 (MMCP-1) positive cell density were assayed histologically. Serum MMCP-1 and immunoglobulins were quantified by ELISA, and mRNA expressions of IFN-gamma, IL-4, IL-6 and TGFbeta-1 from jejunal and ileal tissue segments were analyzed with quantitative real-time PCR. Results: Ovalbumin-specific serum IgE correlated with jejunal MMCP-1+ cell density. In the allergic mice, higher concentrations of carbachol were required to reach submaximal muscular stimulation, particularly in preparations derived from mice with diarrhoea. Decreased sensitivity to carbachol was associated with increased expression of IL-4 and IL-6 mRNA in jejunum. Smooth muscle layer thickness, as well as mRNA of IFN-gamma and TGF-beta1 remained unchanged. Conclusions: In this mouse model of food allergy, we demonstrated a decreased response to a muscarinic agonist, and increased levels of proinflammatory IL-6 and Th2-related IL-4, but not Th1-related IFN-gamma mRNAs in jejunum. IgE levels in serum correlated with the number of jejunal MMCP-1+ cells, and predicted diarrhoea. Overall, these changes may reflect a protective mechanism of the gut in food allergy. (Source: BMC Gastroenterology)

Abstract Background  The full-thickness Plicator® (Ethicon Endosurgery, Sommerville, NJ, USA) was developed for endoscopic treatment of gastroesophageal reflux disease (GERD). The goal is to restructure the antireflux barrier by delivering transmural pledgeted sutures through the gastric cardia. To date, studies using this device have involved the placement of a single suture to create the plication. The purpose of this study was to evaluate the 12-month safety and efficacy of this procedure using multiple implants to restructure the gastroesophageal (GE) junction. Methods  A multicenter, prospective, open-label trial was conducted at four tertiary centers. Eligibility criteria included symptomatic GERD [GERD Health-Related Quality-of-Life (GERD-HRQL) questionnaire, off of medication], and pathologic reflux (abnormal 24-h pH) requiring daily proton pump inhibitor therapy. Patients with Barrett’s epithelium, esophageal dysmotility, hiatal hernia >3 cm, and esophagitis (grade III or greater) were excluded. All patients underwent endoscopic full-thickness plication with linear placement of at least two transmural pledgeted sutures in the anterior gastric cardia. Results  Forty-one patients were treated. Twelve months post treatment, 74% of patients demonstrated improvement in GERD-HRQL scores by ≥50%, with mean decrease of 17.6 points compared with baseline (7.8 vs. 25.4, p 

Conclusions  Endoscopic full-thickness plication using multiple Plicator implants can be used safely and effectively to improve GERD symptoms and reduce medication use. Content Type Journal ArticleDOI 10.1007/s00464-009-0490-7Authors D. von Renteln, Klinikum Ludwigsburg, Teaching Hospital of the Heidelberg University Department of Gastroenterology, Hepatology and Oncology Ludwigsburg GermanyI. Schiefke, University of Leipzig Department of Gastroenterology Leipzig GermanyK. H. Fuchs, Markuskrankenhaus Department of Surgery Frankfurt GermanyS. Raczynski, University of Leipzig Department of Gastroenterology Leipzig GermanyM. Philipper, EVK Medizinische Klinik Duesseldorf GermanyW. Breithaupt, Markuskrankenhaus Department of Surgery Frankfurt GermanyK. Caca, Klinikum Ludwig...