[Reconstruction of benign biliary tract stenoses. Experimental experience with autologous and heterologous transplants (author's transl)]. / Rekonstruktion benigner Gallengangsstenosen (I). Experimentelle Erfahrungen mit autologen und heterologen Transplantaten.

A pedicled autologous jejunum transplant and a free bovine collagen prosthesis were tried for the treatment of short, benign stenoses of the bile duct in animal experiments. In both cases at follow-up periods of 6--18 months an unrestricted flow of bile was recorded in the plastically dilated bile duct macroscopically, radiologically and by the chemical laboratory. On the basis of these results in animal experiments, 3 patients were treated with a pedicled jejunum transplant for the correction of short benign stenosis of the bile duct following previous cholecystectomy. All the patients are free from complaints after observation periods of 6 months, 1 year and 2 1/2 years.

[Problem in indication and artificial ventilation during segmental resection of the trachea (author's transl)]. / Probleme der Indikation und Beatmung bei Segmentresektion der Trachea.

Based on clinical experience and lung function data (bronchial resistance and inspiratory and expiratory FEV1) obtained in experiments with stenosis in the front of the mouth, bronchial resistance and inspiratory and expiratory FEV1 should first be determined. Resection of tracheal stenosis is indicated at a bronchial resistance of more than 5 cm H2O/1/s. This corresponds to a stenosis diameter of less than 8 mm. In the case of carinal resection, one lung can be ventilated by artifical respiration for a short time only. The data obtained during resection confirm the well-known requirement of clamping the opposite pulmonary artery.

[Therapy of benign bile duct stenosis (author's transl)]. / Zur Therapie der benignen choledochusstenose.

Simple end-to-end reconstruction of benign bile duct stenosis is possible only in a few cases. To preserve the function of papilla of Vater as the best anticholangitis therapy, we developed a method of bile duct expansion by a pedunculated jejunal patch-graft in animal experiments. After these successful experiments three patients with iatrogenic short bile duct stenosis were treated with this operation. These patients remain free of pathologic clinical and radiological findings 8-30 months after surgery.

Surgical treatment of tracheal stenosis.

During the last 3 1/2 years 8 patients underwent segmental resection of the trachea and one patient underwent resection of the carina at the Department of Surgery, University Hospital, Köln. Follow-up investigation in 6 month intervals showed good results in 6 patients. The complicated course of 1 of our patients with tumor infiltration of the trachea is discussed. In this case a large esophagotracheal fistula was covered with a vascularized esophageal segment. Suggestions for surgical indications in segmental resection of benign esophageal stenosis are outlined.

[Indications for the correction of tracheal stenosis caused by prolonged artificial ventilation of polytraumatized persons (author's transl)]. / Indikation zur operativen Versorgung von Trachealstenosen nach Langzeitbeatmung Polytraumatisierter.

Pronounced, short-length narrowing of the trachea combined with dyspnoea at rest is an absolute indication for partial resection. For stenoses of moderate degree the indications for surgical intervention are as yet not clearly defined. They depend not only on the clinical, roentgenological and tracheobronchoscopic findings, but also on the results of lung function tests. Changes in respiratory function become noticeable at reduction of under 30% of the tracheal diameter. Experiments with artificially induced stenosis have shown an exponential rise in flow resistance when the diameter of the trachea was narrowed to below 8 millimetre. observations made in patients have proved that the experimental results also apply clinically. The indications for surgery of a tracheal stenosis should be made dependent on the results of the determinations of flow resistance, whole body plethysmography and expiratory and inspiratory volume/1 sec. Flow resistance exceeding 5 cm H2O/1 sec, equivalent to narrowing to under 8 mm in diameter, is considered to be an indication for partial resection.

[Bile duct reconstruction with pendunculate jejunal grafts (author's transl)]. / Gallengangsplastik mit gestieltem Jejunum-Transplantat.

A pedunculate patch, obtained from a disconnected segment of jejunum, was implanted into the longitudinal incision of the ductus choledochus. Intra-operatively, the findings were based upon direct cholecystocholangiography; postoperatively, upon laboratory tests. After an observation period of 12 months a new cholangiography of the transplant was made along with a selective picture of the mesenteric arteries. The choledochus duct with the transplant was examined histologically. Three dogs died immediately postoperatively of peritonitis due to suture insufficiency. Five dogs died of invaginate ileus. These animals, as well as the remaining 8 dogs showed macroscopically and microscopically a smooth and uneventful healing of the transplant at the end of the observation period. Radiographies showed free flow of the biliary duct system. The selective mesenteric arteriographies evidenced beginning anastomosis between the transplant and the capillaries of the bile duct. Based on the results presented, the pedunculate jejunal graft can be considered well suited as an expansion graft for the bile duct.