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Jairam AP, López-Cano M, Garcia-Alamino JM, Pereira JA, Timmermans L, Jeekel J, Lange J, Muysoms F. Prevention of incisional hernia after midline laparotomy with prophylactic mesh reinforcement: a meta-analysis and trial sequential analysis. BJS Open 2020; 4:357-368. [PMID: 32057193 PMCID: PMC7260413 DOI: 10.1002/bjs5.50261] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 12/17/2019] [Indexed: 02/04/2023] Open
Abstract
Background Incisional hernia is a frequent complication after abdominal surgery. The aim of this study was to assess the efficacy of prophylactic mesh reinforcement (PMR) after midline laparotomy in reducing the incidence of incisional hernia. Methods A meta‐analysis was conducted following PRISMA guidelines. The primary outcome was the incidence of incisional hernia after follow‐up of at least 12 months. Secondary outcomes were postoperative complications. Only RCTs were included. A random‐effects model was used for the meta‐analysis, and trial sequential analysis was conducted. Results Twelve RCTs were included, comprising 1815 patients. The incidence of incisional hernia was significantly lower after PMR compared with sutured closure (risk ratio (RR) 0·35, 95 per cent c.i. 0·21 to 0·57; P < 0·001). Both onlay (RR 0·26, 0·11 to 0·67; P = 0·005) and retromuscular (RR 0·28, 0·10 to 0·82; P = 0·02) PMR led to a significant reduction in the rate of incisional hernia. The occurrence of seroma was higher in patients who had onlay PMR (RR 2·23, 1·10 to 4·52; P = 0·03). PMR did not result in an increased rate of surgical‐site infection. Conclusion PMR of a midline laparotomy using an onlay or retromuscular technique leads to a significant reduction in the rate of incisional hernia in high‐risk patients. Individual risk factors should be taken into account to select patients who will benefit most. [Correction added on 19 February 2020, after first online publication: J. García Alamino has been amended to J. M. Garcia‐Alamino]
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Affiliation(s)
- A P Jairam
- Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, Netherlands
| | - M López-Cano
- Department of General and Digestive Surgery, Hospital Vall d'Hebrón, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - J M Garcia-Alamino
- Department of Primary Health Care Sciences, University of Oxford, Oxford, UK
| | - J A Pereira
- Department of General and Digestive Surgery, Hospital Del Mar, Barcelona, Spain
| | - L Timmermans
- Department of Surgery, Maasstad Ziekenhuis Rotterdam, Rotterdam, Netherlands
| | - J Jeekel
- Department of General Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - J Lange
- Department of General Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - F Muysoms
- Department of Surgery, Maria Middelares Hospital, Ghent, Belgium
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2
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van Rooijen MMJ, Jairam AP, Tollens T, Jørgensen LN, de Vries Reilingh TS, Piessen G, Köckerling F, Miserez M, Windsor ACJ, Berrevoet F, Fortelny RH, Dousset B, Woeste G, van Westreenen HL, Gossetti F, Lange JF, Tetteroo GWM, Koch A, Kroese LF, Jeekel J. A post-market, prospective, multi-center, single-arm clinical investigation of Phasix™ mesh for VHWG grade 3 midline incisional hernia repair: a research protocol. BMC Surg 2018; 18:104. [PMID: 30458747 PMCID: PMC6247668 DOI: 10.1186/s12893-018-0439-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 11/07/2018] [Indexed: 02/05/2023] Open
Abstract
Background Incisional heia is a frequent complication of midline laparotomy. The use of mesh in hernia repair has been reported to lead to fewer recurrences compared to primary repair. However, in Ventral Hernia Working Group (VHWG) Grade 3 hernia patients, whose hernia is potentially contaminated, synthetic mesh is prone to infection. There is a strong preference for resorbable biological mesh in contaminated fields, since it is more able to resist infection, and because it is fully resorbed, the chance of a foreign body reaction is reduced. However, when not crosslinked, biological resorbable mesh products tend to degrade too quickly to facilitate native cellular ingrowth. Phasix™ Mesh is a biosynthetic mesh with both the biocompatibility and resorbability of a biological mesh and the mechanical strength of a synthetic mesh. This multi-center single-arm study aims to collect data on safety and performance of Phasix™ Mesh in Grade 3 hernia patients. Methods A total of 85 VHWG Grade 3 hernia patients will be treated with Phasix™ Mesh in 15 sites across Europe. The primary outcome is Surgical Site Occurrence (SSO) including hematoma, seroma, infection, dehiscence and fistula formation (requiring intervention) through 3 months. Secondary outcomes include recurrence, infection and quality of life related outcomes after 24 months. Follow-up visits will be at drain removal (if drains were not placed, then on discharge or staple removal instead) and in the 1st, 3rd, 6th, 12th, 18th and 24th month after surgery. Conclusion Based on evidence from this clinical study Depending on the results this clinical study will yield, Phasix™ Mesh may become a preferred treatment option in VHWG Grade 3 patients. Trial registration The trial was registered on March 25, 2016 on clinicaltrials.gov: NCT02720042.
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Affiliation(s)
- M M J van Rooijen
- Erasmus University Medical Centre Rotterdam, Department of Surgery, Rotterdam, The Netherlands.
| | - A P Jairam
- Erasmus University Medical Centre Rotterdam, Department of Surgery, Rotterdam, The Netherlands
| | - T Tollens
- Imelda Hospital, Department of General Surgery, Bonheiden, Belgium
| | - L N Jørgensen
- University of Copenhagen, Bispebjerg Hospital, Department of Surgery, Copenhagen, Denmark
| | | | - G Piessen
- Department of Surgery, University Hospital Lille, Lille, France
| | - F Köckerling
- Vivantes Klinikum Spandau, Department of Surgery, Berlin, Germany
| | - M Miserez
- Department of Abdominal Surgery, University Hospital Leuven, Leuven, Belgium
| | - A C J Windsor
- Department of Colorectal Surgery, University College London Hospital, London, UK
| | - F Berrevoet
- Department of General and Hepatobiliary Surgery, University Hospital Ghent, Ghent, Belgium
| | - R H Fortelny
- Wilhelminenhospital, Department of General, Visceral and Oncologic Surgery, Vienna, Austria
| | - B Dousset
- Hôpital Cochin, Department of Digestive, Hepatobiliary and Endocrine Surgery, Paris, France
| | - G Woeste
- Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt am Main, Germany
| | | | - F Gossetti
- Università di Roma Sapienza, Rome, Italy
| | - J F Lange
- Erasmus University Medical Centre Rotterdam, Department of Surgery, Rotterdam, The Netherlands
| | - G W M Tetteroo
- IJsselland Ziekenhuis, Department of Surgery, Capelle aan den Ijssel, The Netherlands
| | - A Koch
- Chirurgische Praxis Cottbus, Cottbus Area, Germany
| | - L F Kroese
- Erasmus University Medical Centre Rotterdam, Department of Surgery, Rotterdam, The Netherlands
| | - J Jeekel
- Erasmus University Medical Centre Rotterdam, Department of Surgery, Rotterdam, The Netherlands
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Kaufmann R, Jairam AP, Mulder IM, Wu Z, Verhelst J, Vennix S, Giesen LJX, Clahsen-van Groningen MC, Jeekel J, Lange JF. Characteristics of different mesh types for abdominal wall repair in an experimental model of peritonitis. Br J Surg 2017; 104:1884-1893. [PMID: 28901533 DOI: 10.1002/bjs.10635] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/17/2017] [Accepted: 06/05/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND The use of synthetic mesh to repair a potentially contaminated incisional hernia may lead to higher failure rates. A biological mesh might be considered, but little is known about long-term results. Both biological and synthetic meshes were investigated in an experimental model of peritonitis to assess their characteristics in vivo. METHODS Male Wistar rats were randomized into five groups and peritonitis was induced. A mesh was implanted after 24 h. Five meshes were investigated: Permacol™ (cross-linked collagen), Strattice™ (non-cross-linked collagen), XCM Biologic® (non-cross-linked collagen), Omyra® Mesh (condensed polytetrafluoroethylene) and Parietene™ (polypropylene). The rats were killed after either 30, 90 or 180 days. Incorporation and shrinkage of the mesh, adhesion coverage, strength of adhesions and histology were analysed. RESULTS Of 135 rats randomized, 18 died from peritonitis. Some 180 days after implantation, both XCM Biologic® and Permacol™ had significantly better incorporation than Strattice™ (P = 0·003 and P = 0·009 respectively). Strattice™ had significantly fewer adhesions than XCM Biologic® (P = 0·001) and Permacol™ (P = 0·020). Thirty days after implantation, Permacol™ had significantly stronger adhesions than Strattice™ (P < 0·001). Shrinkage was most prominent in XCM Biologic® , but no significant difference was found compared with the other meshes. Histological analysis revealed marked differences in foreign body response among all meshes. CONCLUSION This experimental study suggested that XCM Biologic® was superior in terms of incorporation, macroscopic mesh infection, and histological parameters such as collagen deposition and neovascularization. There must be sufficient overlap of mesh during placement, as XCM Biologic® showed a high rate of shrinkage. Surgical relevance The use of synthetic mesh to repair a potentially contaminated incisional hernia is not supported unequivocally, and may lead to a higher failure rate. A biological mesh might be considered as an alternative. There are few long-term studies, as these meshes are expensive and rarely used. This study evaluated the use of biological mesh in a contaminated environment, and investigated whether there is an ideal mesh. A new non-cross-linked biological mesh (XCM Biologic® ) was evaluated in this experiment. The new non-cross-linked biological mesh XCM Biologic® performed best and may be useful in patients with a potentially contaminated incisional hernia.
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Affiliation(s)
- R Kaufmann
- Department of Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - A P Jairam
- Department of Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - I M Mulder
- Department of Surgery, Erasmus MC, Rotterdam, The Netherlands.,Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - Z Wu
- Department of Surgery, Erasmus MC, Rotterdam, The Netherlands.,Gastrointestinal Cancer Centre, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - J Verhelst
- Department of Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - S Vennix
- Department of Surgery, Erasmus MC, Rotterdam, The Netherlands.,Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - L J X Giesen
- Department of Surgery, Erasmus MC, Rotterdam, The Netherlands
| | | | - J Jeekel
- Department of Neuroscience, Erasmus MC, Rotterdam, The Netherlands
| | - J F Lange
- Department of Surgery, Erasmus MC, Rotterdam, The Netherlands
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4
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Jairam AP, Kaufmann R, Muysoms F, Jeekel J, Lange JF. The feasibility of local anesthesia for the surgical treatment of umbilical hernia: a systematic review of the literature. Hernia 2017; 21:223-231. [PMID: 28108822 PMCID: PMC5359377 DOI: 10.1007/s10029-017-1577-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 01/06/2017] [Indexed: 11/24/2022]
Abstract
Background Yearly approximately 4500 umbilical hernias are repaired in The Netherlands, mostly under general anesthesia. The use of local anesthesia has shown several advantages in groin hernia surgery. Local anesthesia might be useful in the treatment of umbilical hernia as well. However, convincing evidence is lacking. We have conducted a systematic review on safety, feasibility, and advantages of local anesthesia for umbilical hernia repair. Methods A systematic review was conducted according to the PRISMA guidelines. Outcome parameters were duration of surgery, surgical site infection, perioperative and postoperative complications, postoperative pain, hernia recurrence, time before discharge, and patient satisfaction. Results The systematic review resulted in nine included articles. Various anesthetic agents were used, varying from short acting to longer acting agents. There was no consensus regarding the injection technique and no conversions to general anesthesia were described. The most common postoperative complication was surgical site infection, with an overall percentage of 3.4%. There were no postoperative deaths and no allergic reactions described for local anesthesia. The hernia recurrence rate varied from 2 to 7.4%. Almost 90% of umbilical hernia patients treated with local anesthesia were discharged within 24 h, compared with 47% of patients treated with general anesthesia. The overall patient satisfaction rate varied from 89 to 97%. Conclusion Local anesthesia for umbilical hernia seems safe and feasible. However, the advantages of local anesthesia are not sufficiently demonstrated, due to the heterogeneity of included studies. We, therefore, propose a randomized controlled trial comparing general versus local anesthesia for umbilical hernia repair.
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Affiliation(s)
- A P Jairam
- Department of Surgery, Erasmus University Medical Center Rotterdam, Room Z-835, 3000 CA, Rotterdam, The Netherlands.
| | - R Kaufmann
- Department of Surgery, Erasmus University Medical Center Rotterdam, Room Z-835, 3000 CA, Rotterdam, The Netherlands
| | - F Muysoms
- Department of Surgery, Algemeen Ziekenhuis Maria Middelares, Kortrijksesteenweg 1026, 9000, Ghent, Belgium
| | - J Jeekel
- Department of Neuroscience, Erasmus University Medical Center, Rotterdam, 3000 CA, Rotterdam, The Netherlands
| | - J F Lange
- Department of Surgery, Erasmus University Medical Center Rotterdam, Room Z-835, 3000 CA, Rotterdam, The Netherlands
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5
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Woeste G, Juratli MA, Habbe N, Hannes S, El Youzouri H, Bechstein WO, Trombetta F, Moscato R, Ciamporcero T, Ghiglione F, Morino M, Tahir S, Baldjiev T, Goshev G, Pachoov N, Eftimov E, Kovachevski S, Smirnoff A, Roth JS, Wennergren J, Plymale MA, Zachem A, Davenport DL, Mangiante G, Passeri V, deManzoni G, Kaufmann R, Jairam AP, Mulder IM, Wu Z, Verhelst J, Vennix S, Giessen LJX, Jeekel J, Lange JF, Di Cerbo F, Ikhlawi K, Baladov M, Agha A, Iesalnieks I, Franklin M, Hernandez M, Glass J, Glover M, Gruber-Blum S, Fortelny R, May C, Glaser K, Redl H, Petter-Puchner A, Grossi J, Cavazzola LT, Tezza SLT, Nery LA, Zortea J, Roll S, Gorganchian F, Santa Maria V, Zuvela M, Galun D, Petrovic J, Micev M, Palibrk I, Bidzic N, Colozzi S, Clementi M, Cianca G, Giuliani A, Carlei F, Schietroma M, Amicucci G, Chung M, Cerasani N, Meyer J, Bulian DR, Heiss MM, Kocaay AF, Eker T, Celik SU, Akyol C, Cakmak A. Topic: Abdominal Wall Hernia - Abdominal wall closure. Hernia 2015; 19 Suppl 1:S198-205. [PMID: 26518800 DOI: 10.1007/bf03355349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- G Woeste
- Department of Surgery, Goethe university, Frankfurt, Germany
| | - M A Juratli
- Department of Surgery, Goethe university, Frankfurt, Germany
| | - N Habbe
- Department of Surgery, Goethe university, Frankfurt, Germany
| | - S Hannes
- Department of Surgery, Goethe university, Frankfurt, Germany
| | - H El Youzouri
- Department of Surgery, Goethe university, Frankfurt, Germany
| | - W O Bechstein
- Department of Surgery, Goethe university, Frankfurt, Germany
| | - F Trombetta
- SCDU General Surgery 1, University of Turin, Company City Hospital and Healht Science of Turin, Turin, Italy
| | - R Moscato
- SCDU General Surgery 1, University of Turin, Company City Hospital and Healht Science of Turin, Turin, Italy
| | - T Ciamporcero
- SCDU General Surgery 1, University of Turin, Company City Hospital and Healht Science of Turin, Turin, Italy
| | - F Ghiglione
- SCDU General Surgery 1, University of Turin, Company City Hospital and Healht Science of Turin, Turin, Italy
| | - M Morino
- SCDU General Surgery 1, University of Turin, Company City Hospital and Healht Science of Turin, Turin, Italy
| | - S Tahir
- University Surgical Clinic St. Naum Ohridski, Skopje, R. of Macedonia, European Union
| | - T Baldjiev
- General Hospital, Strumica, Public Health Organization, Strumica, R. of Macedonia, European Union
| | - G Goshev
- General Hospital, Strumica, Public Health Organization, Strumica, R. of Macedonia, European Union
| | - N Pachoov
- General Hospital, Strumica, Public Health Organization, Strumica, R. of Macedonia, European Union
| | - E Eftimov
- General Hospital, Strumica, Public Health Organization, Strumica, R. of Macedonia, European Union
| | - S Kovachevski
- General Hospital, Strumica, Public Health Organization, Strumica, R. of Macedonia, European Union
| | | | - J S Roth
- Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - J Wennergren
- Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - M A Plymale
- Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - A Zachem
- Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - D L Davenport
- Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - G Mangiante
- Upper Digestive Surgery, University of Verona, Verona, Italy
| | | | | | - R Kaufmann
- Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - A P Jairam
- Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - I M Mulder
- Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
- Department of Surgery, Academic Medical Center, Amsterdam, Netherlands
| | - Z Wu
- Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - J Verhelst
- Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - S Vennix
- Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
- Department of Surgery, Academic Medical Center, Amsterdam, Netherlands
| | - L J X Giessen
- Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - J Jeekel
- Department of Neuroscience, Erasmus University Medical Center, Rotterdam, Netherlands
| | - J F Lange
- Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - K Ikhlawi
- Marienhospital Gelsenkirchen, Gelsenkirchen, Germany
| | - M Baladov
- Marienhospital Gelsenkirchen, Gelsenkirchen, Germany
| | - A Agha
- Klinikum Bogenhausen, Munich, Germany
| | | | - M Franklin
- Texas endosurgery Institute, San Antonio, USA
| | - M Hernandez
- Texas endosurgery Institute, San Antonio, USA
| | - J Glass
- Texas endosurgery Institute, San Antonio, USA
| | - M Glover
- Texas endosurgery Institute, San Antonio, USA
| | - S Gruber-Blum
- Department of General, Visceral and Oncologic Surgery, Wilhelminenspital, Vienna, Austria
| | - R Fortelny
- Department of General, Visceral and Oncologic Surgery, Wilhelminenspital, Vienna, Austria
| | - C May
- Department of General, Visceral and Oncologic Surgery, Wilhelminenspital, Vienna, Austria
| | - K Glaser
- Department of General, Visceral and Oncologic Surgery, Wilhelminenspital, Vienna, Austria
| | - H Redl
- Cluster of Tissue engeneering, Ludwig Boltzmann Institute of Traumatology, Vienna, Austria
| | - A Petter-Puchner
- Department of General, Visceral and Oncologic Surgery, Wilhelminenspital, Vienna, Austria
| | - J Grossi
- Brazilian lutern hospital, Canoas, Brazil
| | | | | | | | | | | | - F Gorganchian
- Departamento de Cirugia, Instituto de Investigaciones Medicas A. Lanari, Caba, Argentina
| | - V Santa Maria
- Departamento de Cirugia, Instituto de Investigaciones Medicas A. Lanari, Caba, Argentina
| | - M Zuvela
- Clinical center of Serbia, University Clinic for Digestive Surgery, Belgrade, Serbia
- Medical School, University of Belgrade, Belgrade, Serbia
| | - D Galun
- Clinical center of Serbia, University Clinic for Digestive Surgery, Belgrade, Serbia
- Medical School, University of Belgrade, Belgrade, Serbia
| | - J Petrovic
- Clinical center of Serbia, University Clinic for Digestive Surgery, Belgrade, Serbia
| | - M Micev
- Clinical center of Serbia, University Clinic for Digestive Surgery, Belgrade, Serbia
- Medical School, University of Belgrade, Belgrade, Serbia
| | - I Palibrk
- Clinical center of Serbia, University Clinic for Digestive Surgery, Belgrade, Serbia
- Medical School, University of Belgrade, Belgrade, Serbia
| | - N Bidzic
- Clinical center of Serbia, University Clinic for Digestive Surgery, Belgrade, Serbia
| | - S Colozzi
- Ospedale Civile San Salvatore, L'Aquila, Italy
| | | | | | | | | | | | | | - M Chung
- Gil Medical Center, Gachon University, Incheon, South Korea
| | - N Cerasani
- Department of Abdominal-, Vascular and Transplant Surgery, Cologne-Merheim Medical Center University of Witten/Herdecke, Cologne, Germany
| | - J Meyer
- Department of Abdominal-, Vascular and Transplant Surgery, Cologne-Merheim Medical Center University of Witten/Herdecke, Cologne, Germany
| | - D R Bulian
- Department of Abdominal-, Vascular and Transplant Surgery, Cologne-Merheim Medical Center University of Witten/Herdecke, Cologne, Germany
| | - M M Heiss
- Department of Abdominal-, Vascular and Transplant Surgery, Cologne-Merheim Medical Center University of Witten/Herdecke, Cologne, Germany
| | - A F Kocaay
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - T Eker
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - S U Celik
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - C Akyol
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - A Cakmak
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
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