Collagen distribution and expression of matrix metalloproteinases 1 and 13 in patients with anastomotic leakage after large-bowel surgery

Stumpf, M.; Cao, Wei; Klinge, U.; Klosterhalfen, B.; Kasperk, Reinhard; Schumpelick, Volker

doi:10.1007/s00423-001-0255-9

Cited by 40 publications

(27 citation statements)

References 33 publications

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“…die durchgeführte Nahttechnik, die Durchblutung der Anastomose, Ausbildung eines Hämatoms, elektrisch-thermische Nekrosen, Gewebsischämie, Kontamination und eine nicht spannungsfrei angelegte Anastomose. Als systemische Faktoren gelten schlechter Ernährungszustand, Rauchen, hohes Alter, Begleiterkrankungen, Medikamente (insbesondere Antikoagulanzien, Immunsuppressiva, Zytostatika) und Störungen des Kollagenstoffwechsels [33,34,35]. Als Ursache für frühe Anastomoseninsuffizienzen (2.-5. postoperativer Tag) gelten operativ-technische Prob- [29].…”

Section: Inzidenz Und Risikofaktorenunclassified

Insuffizienzen nach Eingriffen am unteren Gastrointestinaltrakt

Willis

Stumpf

2004

Chirurg

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The incidence of anastomotic leakage in colorectal surgery is 1% to 12%. Every deviation from the normal postoperative course must raise suspicion of a leak. Diagnosis is made radiologically by rectal enema or CT. Limited leakages without clinical signs can be treated conservatively by wait-and-see. Larger anastomotic failure with intra-abdominal abscesses or peritonitis requires reanastomosis in combination with a diverting loop ileostomy or colostomy. A Hartmann procedure with open abdominal management may be indicated in severely ill patients with feculent peritonitis. In the pelvis, even large leaks may heal spontaneously when stool passage is diminished by a proximal diverting enterostomy. There is no benefit of primary loop enterostomies concerning the incidence of anastomotic leaks; however, they reduce the number of operative revisions due to anastomotic failure. Therefore they are proposed in risk patients and intraoperatively difficult anastomoses.

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Section: Inzidenz Und Risikofaktorenunclassified

Insuffizienzen nach Eingriffen am unteren Gastrointestinaltrakt

Willis

Stumpf

2004

Chirurg

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“…So far, only preliminary evidence indicates that the presence of MMP-13 in the bowel wall at the time of operation may predispose for wound dehiscence after colorectal surgery. 34 …”

Section: Discussionmentioning

confidence: 97%

Changes in Gelatinase Activity in the Gastrointestinal Tract After Anastomotic Construction in the Ileum or Colon

Hingh

Lomme

Goor

et al. 2005

Diseases of the Colon &Amp; Rectum

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“…Eine an unserer Klinik durchgeführte Pilotstudie ergab erste Hinweise auf analoge Veränderungen der Extrazellulärma-trix bei Patienten mit Anastomosenheilungsstörungen [49]. Die Ergebnisse einer anschließenden prospektiven Untersuchung konnten diese Beobachtung bestätigen.…”

Section: Veränderungen Der Extrazellulärmatrixunclassified

Anastomotic leakage in the gastrointestinal tract?repair and prognosis

Stumpf

Klinge

Mertens

2004

Chirurg

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Anastomotic leakage is still a serious complication in surgery, resulting in increased morbidity and mortality. The reasons for its onset are various and due to two main reasons: general risk factors of the individual patient and technical surgical factors influencing the outcome after gastrointestinal anastomoses. Changes in the extracellular matrices, particularly due to collagen metabolism, and related disturbances are assumed to be important factors influencing wound healing processes. The technique chosen and the surgical skill are important with regard to inflammation and tissue necroses at the anastomotic line. Analysis of data obtained by clinical studies that concern clinical risk factors for anastomotic leakage reveal an inhomogeneous picture. Attempts to develop risk profiles or scores based on these results have failed until now. Problems encompass the complexity of wound healing processes, and it is questionable whether our current knowledge about them is complete. Therefore, profound understanding of anastomotic leakage requires in-depth analysis of the interaction of extracellular matrix components. Preliminary results indicate the presence of a risk population with collagen metabolism disturbances that have a major effect on wound healing after gastrointestinal anastomosis.

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Collagen distribution and expression of matrix metalloproteinases 1 and 13 in patients with anastomotic leakage after large-bowel surgery

Cited by 40 publications

References 33 publications

Insuffizienzen nach Eingriffen am unteren Gastrointestinaltrakt

Insuffizienzen nach Eingriffen am unteren Gastrointestinaltrakt

Changes in Gelatinase Activity in the Gastrointestinal Tract After Anastomotic Construction in the Ileum or Colon

Anastomotic leakage in the gastrointestinal tract?repair and prognosis

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