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Laparoscopic resections of the pancreatic head are increasingly performed. Several studies show that they are comparable to open operations in terms of postoperative morbidity. However, since a substantial proportion of pancreatic head resections are necessary for pancreatic adenocarcinoma the oncologic safety and outcome of minimally invasive operations is of interest. In this study we evaluated oncologic outcome and survival after laparoscopically assisted pancreatic head resection for ductal adenocarcinoma.Perioperative and oncological outcome of sixty-two laparoscopically assisted pancreatic head resections for pancreatic ductal adenocarcinoma performed between 2010 and 2016 was compared to outcome of 278 open resections between 2001 and 2016 in a retrospective study. Data was continuously collected in a prospectively maintained database.Operation time was significantly longer in the laparoscopic group (477 vs. 428 min. p 0.001). Tumor size, lymph node yield and lymph node state and need of portal vein resection were comparable. There was a higher rate of free resection margins in the laparoscopic group (87% vs. 71%, p 0.01). There was no difference in postoperative mortality and morbidity. Patients with laparoscopic resection stayed in hospital significantly shorter (median 14 vs. 16 days, p 0.003). Postoperative survival after 5 years was not different in both groups.Laparoscopically assisted resection of adenocarcinoma of the pancreatic head is equal to open resection concerning oncologic outcome and actuarial survival. However, minimally invasive resection shortened the hospital stay. However, further evaluations with a longer follow up time are needed.

Metabolic surgery is known to impact glucose tolerance but the exact mechanism is still unclear. Based on recently-published data, especially the role of the hindgut may require redefinition.Either a loop duodeno-jejunostomy (DJOS) with exclusion of one third of total intestinal length, a loop duodeno-ileostomy (DiOS, exclusion of two thirds), or SHAM operation was performed in 9-week-old Zucker diabetic fatty rats. One, 3, and 6 months after surgery, an oral glucose tolerance test (OGTT) and glucose-stimulated hormone analyses were conducted. Body weight was documented weekly.DJOS and DiOS animals showed significantly better glucose control in all OGTTs than the SHAM group (two-way ANOVA p 0.0001). Body weight developed largely parallel in both intervention groups; SHAM animals had gained significantly less weight after 6 months (Mann-Whitney DJOS/DiOS vs. SHAM p 0.05, DJOS vs. DiOS p 0.05). Operative interventions had no impact on GLP-1 and GIP levels at any time point (Mann-Whitney p 0.05 for all). DJOS/DiOS operations could preserve insulin production up to 6 months, while there was already a sharp decline of insulin levels in the SHAM group (Mann-Whitney: DJOS/DiOS vs. SHAM p 0.05 for all time points). Additionally, insulin sensitivity was improved significantly 1 month postoperative in both intervention groups compared to SHAM (Mann-Whitney DJOS/DiOS vs. SHAM p 0.05).The data of the current study demonstrate a sharp amelioration of glucose control after duodenal exclusion with unchanged levels of GLP-1 and GIP. Direct or delayed hindgut stimulation had no impact on glucose control in our model.

Laparoscopic sleeve gastrectomy (LSG) can achieve excellent weight loss, yet sleeve dilatation with concomitant weight regain proves to be a relevant issue. Hence, additional restriction might improve results after LSG. In a retrospective matched-pair analysis, 42 patients who underwent banded LSG (BLSG) using a MiniMizer® ring between January 2012 and October 2014 were analysed regarding weight loss, complications and comorbidity. Median follow-up was 3 years. Forty-two patients who had undergone conventional LSG were selected as matched pairs. Mean preoperative BMI was 54.93 ± 7.42 kg/m2 for BLSG and 53.46 ± 6.69 kg/m2 for LSG (Mann-Whitney P = 0.540). Total weight loss (%TWL) was significantly greater in the BLSG group 3 years after surgery (BLSG 38.22% ± 7.26; n = 26 vs. LSG 32.69 ± 9.47; n = 26; P = 0.0154). Ring placement had no relevant impact on new-onset reflux (Fisher’s exact test P = 1.0) but a tendency towards reflux improvement when reflux pre-existed (odds ratio 1.96). The major side effect of ring implantation was regurgitation with over 44% of patients presenting with regurgitation >1 per week (Fisher’s exact test P = 0.0019, odds ratio 18.07). BLSG is a safe procedure showing similar comorbidity to conventional LSG. However, BLSG leads to a higher rate of postoperative regurgitation. Weight loss is significantly improved 3 years after surgery. Hence, additional ring implantation might be an option for increased restriction in LSG surgery.

Minimalinvasive Operationstechniken finden in letzter Zeit auch in der Pankreaschirurgie zunehmend Verwendung. Die totale Pankreatektomie ist im Vergleich zur Pankreaskopf- und Pankreaslinksresektion nur selten indiziert. Da keine Pankreasanastomose angelegt werden muss und zur offenen Resektion eine ausgedehnte Oberbauchlaparotomie notig ist, erscheint die laparoskopisch-assistierte Vorgehensweise vorteilhaft. Es wird von der initialen Erfahrung mit der laparoskopisch-assistierten totalen Pankreatektomie bei 3 Patienten berichtet. Zwei Patienten mit intraduktaler papillar-muzinoser Neoplasien (IPMN) im Hauptgang des Pankreas und ein Patient mit Metastasen eines Nierenzellkarzinoms im Pankreas wurden in die Machbarkeitsstudie aufgenommen. Bei allen 3 Operationen wurde die Resektion laparoskopisch durchgefuhrt; die Rekonstruktion erfolgte uber den Bergeschnitt. Die Ergebnisse in Bezug auf Operationszeit, Blutverlust und „Intermediate-care“(IMC)-/Krankenhausaufenthalt waren bei den laparoskopisch-operierten Patienten nicht schlechter als bei einem Vergleichskollektiv von 7 offenen Resektionen. Vorbehaltlich der noch geringen Patientenanzahl ist die laparoskopisch-assistierte totale Pankreatektomie ein durchfuhrbares Verfahren in chirurgischen Zentren mit hoher laparoskopischer und pankreaschirurgischer Expertise.

Proteins of the pregnancy specific β-1 glycoprotein (PSG) family are renowned for their elevated expression during pregnancy. Only few reports have investigated their expression in adenocarcinomas. We studied the expression of PSG1 in pancreatic adenocarcinoma (PDAC). In a cohort of 104 patient samples, immunohistochemical analysis determined PSG1 expression in every specimen. PSG1 was found at apical and cytoplasmic localization or solely at cytoplasmic localization, with the latter case being correlated to shortened median survival (25 vs 11 months, logrank p-value < 0.001). At the same time, enzyme linked immunosorbent assay (ELISA) did not detect elevated PSG1 levels in the plasma of PDAC patients as opposed to the plasma of healthy, non-pregnant control individuals. We also probed the impact of PSG1 expression in a murine tumor model system, using subcutaneous injection of Colo-26 cells into immunocompetent BALB/c mice. Here, tumor growth was not affected by the expression of human PSG1. Our study reaffirms interest into the tumor-contextual biology of PSG proteins.

Laparoscopic sleeve gastrectomy (LSG) has been described as the first step of a two-step laparoscopic Roux-en-Y gastric bypass (LRYGB) or biliopancreatic diversion with duodenal switch (BPD-DS) in extremely obese patients. It has also been used as an independent bariatric procedure. Recently a banded sleeve gastrectomy using human dermis was published. Gastric sleeve dilatation is one of the unfavorable postoperative courses that may limit weight loss. Our technique of a banded sleeve gastrectomy using the GaBP Ring Autolock(TM) System to calibrate the sleeve and prevent distal sleeve dilatation is described in this article.

Background Laparoscopic sleeve gastrectomy (LSG) is generally considered a restrictive procedure. However, studies with nuclear medicine techniques have demonstrated that gastric motility changes occur following LSG. These motility changes could represent complementary mechanisms of weight loss. Therefore, we analyzed the stomach motility before and after LSG by means of dynamic MRI.

Background: Fundamental experimental research into intestinal anastomotic healing in rodent models will gain increasing interest in the future. Methods: The aim of this study was to describe our 5-year experience with a standardized experimental setup of small and large bowel anastomoses in a rodent model and present a basic set of assessment tools investigating anastomotic healing. Anastomotic technique, perioperative complications such as anastomotic insufficiency (AI) and obstructive ileus were in the focus. Results: During different studies with varying study patterns, 167 rat small bowel anastomoses and 120 colonic anastomoses were performed. Overall mortality was 3.6% in small bowel and 2.5% in colonic anastomoses, AI occurred in 2.9 and 4%, respectively. A postoperative obstructive ileus was seen in 3/167 small bowel anastomoses and none in the colonic group. Conclusion: When performing experimental intestinal anastomoses in a standardized operative setting and critically considering special perioperative issues, the incidence of relevant complications can be maintained at an adequately low level.

Because of the growing prevalence of morbid obesity, bariatric surgery is getting more and more important. According to the growing number of bariatric operations, the number of patients in need of revisionary surgery is also growing, mostly because of insufficient weight loss. This article gives an outline of indications, preoperative diagnostics and revisionary operations in bariatric surgery.

Introduction In bariatric surgery, still new surgical techniques are developed. On the one hand, the Roux-en-Y gastric bypass (RYGB) is one of the most common procedures used. However, many patients experience dumping syndrome or pain due to bile reflux. On the other hand, revisions after gastric banding are frequent and may be technically challenging. Aim To create a new bariatric procedure counterbalancing the drawbacks of conventional RYGB, also suitable as a redo option after gastric banding. Material and methods To diminish the complication rate and pathophysiological disadvantages in reoperations after gastric banding, we primarily combined a gastric plication (GP) with a single anastomosis duodeno-ileal omega switch (DIOS), bypassing 2/3 of the total bowel length. Further on, in patients with lower body mass index we combined a GP or LSG and laparoscopic sleeve gastrectomy with a duodeno-jejunal omega switch (DJOS), performing an end-to side anastomosis after 1/3 of the total bowel length. Results The DIOS and DJOS techniques restrict food intake and bypass the duodenum and part (DJOS) or the whole (DIOS) jejunum. Restriction is achieved either through gastric plicature or conventional sleeve gastrectomy. Conclusions Similar bariatric and metabolic effects to proximal RYGB are expected in the case of DJOS, or to a conventional duodenal switch when performing a DIOS procedure. Performing a gastric plicature will reduce the risk of gastric leak when revising patients after failed gastric banding.

Despite improvements in treatment, pancreatic ductal adenocarcinoma (PDAC) remains one of the most lethal cancers, with a continuous increase in incidence emphasizing the need for further research and therapeutic development. In recent years, we have developed a collection of >40 patient-derived xenograft (PDX) models from PDAC. In order to determine their relevance for anticancer agent testing, we extensively characterized our models for histology features, whole exome mutations (Hiseq 2000), chromosome rearrangements, gene copy number variations (Affymetrix SNP6) and gene expression (Affymetrix U133 Plus2.0). PDAC from 65 patients were implanted into immuno-compromised mice, resulting in the development of 42 PDX models (success rate 65%). The PDAC from which models were established included moderate and poorly differentiated tumors and were heterogeneous for stroma content. In patient tumors, we showed fibroblast activation but not stroma content predicted poor patient outcome (p Extensive characterization of our PDAC_PDX collection revealed similarities with patient tumors with regards of histology features including stroma content and fibroblast activation. At molecular level, the models showed similar genomic and transcriptomic patterns as those reported for patient PDAC, altogether, proving the value of this collection for drug development investigations. Citation Format: Peter Bronsert, Tim Kees, Bruno Zeitouni, Anne-Lise Peille, Manuel Landesfeind, Heinz-Herbert Fiebig, Simon Kuesters, Vincent Vuaroqueaux. Subtyping of pancreatic cancer patient-derived xenograft tumors and implications for anticancer agent testing. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 639.

Supplemental Digital Content is available in the text, Pancreatic ductal adenocarcinoma (PDAC) is characterized by a strong fibrotic stromal reaction and diffuse growth pattern. Peritumoral fibrosis is often evident during surgery but only distinguishable from tumor by microscopic examination. The aim of this study was to investigate the role of clearance of fibrotic stromal reaction at the mesopancreatic resection margin as a criterion for radical resection and preoperative assessment of resectability. Mesopancreatic stromal clearance status (S-status) was defined as the presence or absence (S+/S0) of fibrotic stromal reaction at the mesopancreatic resection margin. Detailed retrospective clinicopathologic re-evaluation of margin status and preoperative cross-sectional imaging was performed in a cohort of 91 patients operated for pancreatic head PDAC from 2001 to 2011. Conventional margin positive resection (R+, tumor cells directly at the margin) was found in 36%. However, S-status further divided the margin negative (R0) group into patients with median survival of 14 months versus 31 months (S+ versus S0, P = 0.005). Overall rate of S+ was 53%. S-status and lymph node ratio constituted the only independent predictors of survival. Stranding of the superior mesenteric artery fat sheath was the only independent radiologic predictor of S+ resection, and achieved a 71% correct prediction of S-status. Mesopancreatic stromal clearance is a major determinant of curative resection in PDAC, and preoperative prediction by cross-sectional imaging is possible, setting the basis for a new definition of borderline resectability.

A "step-up" approach is currently the treatment of choice for acute necrotizing pancreatitis. Our aim was to evaluate the outcome of minimally invasive retroperitoneal necrosectomy (MINE) and endoscopic transgastric necrosectomy (ETG) and to compare it to open necrosectomy (ONE).Patients with acute pancreatitis admitted to our institution from 1998 to 2010 (n = 334) were identified. From these, patients who underwent either ONE, MINE, or ETG were selected for further analysis. Statistical analysis employed 2-sided Fisher's exact test and Mann-Whitney U-test.From 2002 to 2010, 32 patients with acute necrotizing pancreatitis were treated by minimally invasive procedures including MINE (n = 14) and ETG (n = 18) or with the classic technique of ONE (n = 30). Time from onset of symptoms to intervention was less for ONE than for MINE or ETG (median, 11 vs 39 vs 54 days; P.05). The rate of critically ill patients with sepsis or septic shock was greatest in ONE (93%) and MINE (71%) compared with ETG (17%; P.05). Problems after ONE and MINE were ongoing sepsis (ONE 73% vs MINE 29% vs ETG 11%) and bleeding requiring intervention (ONE 26% vs MINE 21% vs ETG 17%). A specific complication of ETG was gastric perforation into the peritoneal cavity during the procedure (28%), requiring immediate open pseudocystogastrostomy. Laparotomy was necessary in 21% after MINE and 28% after ETG owing to specific complications or persistent infected necrosis. Overall mortality was greatest after ONE (ONE 63% vs MINE 21% vs ETG 6%; P.05).Morbidity and mortality remains high in acute necrotizing pancreatitis. Operative procedures should be delayed as long as possible to decrease morbidity and mortality. Minimally invasive procedures can avoid laparotomy, but also introduce specific complications requiring immediate or secondary open operative treatment. Minimally invasive procedures require unique expertise and therefore should only be performed at specialized centers.

Morbid obesity strongly affects patients' quality of life (QoL). Thus it is mandatory to include evaluation of QoL in the follow-up and outcome assessment after bariatric surgery. There are a number of tests to evaluate healthrelated QoL. Some are generic, like the Medical Outcome Study Short Form 36 (SF-36), others are obesity specific, like the Impact of Weight on Quality of Life (IWQOL and IWQOL-Lite), and some are specific for outcome evaluation after bariatric operations, like the Bariatric Analysis and Reporting Outcomes System (BAROS) and the Bariatric Quality of Life Index (BQL). There are also a number of studies concerning QoL after bariatric surgery. This article describes the most common test forms, gives an overview of the pertinent literature, and provides information about when to use which test form.

Along with the rapid increase in obesity comes an increase of associated comorbidities in particular type 2 diabetes mellitus (T2DM). These comorbidities and again in particular T2DM limit patients life time and life quality to a considerable extend. Fortunately bariatric surgery shows effects not only on body weight but also on glucose homoeostasis. For some operations the long term results concerning diabetes even exceed those concerning weight loss. Patients remain overweight but experience remission from diabetes. The question arises if we should rather talk of “ diabetes surgery” than “bariatric surgery” when operating an obese patient with T2DM [1-2]. The next step would consequently be the “anti-diabetic” operation of non-obese patients with inadequately-controlled diabetes [3-5]. The biliopancreatic diversion with duodenal switch (BPD-DS) is a well-established bariatric operation with encouraging effects on glucose homeostasis and diabetes which will be discussed in the present chapter [6].

Different types of single-incision laparoscopic surgery (SILS) have become increasingly popular. Although SILS is technically even more challenging than conventional laparoscopy, published data of first clinical series seem to demonstrate the feasibility of these approaches. Various attempts have been made to overcome restrictions due to loss of triangulation in SILS by specially designed SILS-specific instruments. This study involving novices in a dry lab compared task performances between conventional laparoscopic surgery (CLS) and single-port laparoscopic surgery (SPLS) using newly designed pre-bent instruments. In this study, 90 medical students without previous experience in laparoscopic techniques were randomly assigned to undergo one of three procedures: CLS, SPLS using two pre-bent instruments (SPLS-pp), or SPLS using one pre-bent and one straight laparoscopic instrument (SPLS-ps). In the dry lab, the participants performed four typical laparoscopic tasks of increasing difficulty. Evaluation included performance times or number of completed tasks within a given time frame. All performances were videotaped and evaluated for unsuccessful attempts and unwanted interactions of instruments. Using subjective questionnaires, the participants rated difficulties with two-dimensional vision and coordination of instruments. Task performances were significantly better in the CLS group than in either SPLS group. The SPLS-ps group showed a tendency toward better performances than the SPLS-pp group, but the difference was not significant. Video sequences and participants` questionnaires showed instrument interaction as the major problem in the single-incision surgery groups. Although SILS is feasible, as shown in clinical series published by laparoscopically experienced experts, SILS techniques are demanding due to restrictions that come with the loss of triangulation. These can be compensated only partially by currently available SILS-designed instruments. The future of SILS depends on further improvements in the available equipment or the development of new approaches such as needlescopically assisted or robotically assisted procedures.

AIM: To investigate the influence of remote ischemic preconditioning (RIPC) on anastomotic integrity. METHODS: Sixty male Wistar rats were randomized to six groups. The control group (n = 10) had an end-to-end ileal anastomosis without RIPC. The preconditioned groups (n = 34) varied in time of ischemia and time of reperfusion. One group received the amino acid L-arginine before constructing the anastomosis (n = 9). On postoperative day 4, the rats were re-laparotomized, and bursting pressure, hydroxyproline concentration, intra-abdominal adhesions, and a histological score concerning the mucosal ischemic injury were collected. The data are given as median (range). RESULTS: On postoperative day 4, median bursting pressure was 124 mmHg (60-146 mmHg) in the control group. The experimental groups did not show a statistically significant difference (P > 0.05). Regarding the hydroxyproline concentration, we did not find any significant variation in the experimental groups. We detected significantly less mucosal injury in the RIPC groups. Furthermore, we assessed more extensive intra-abdominal adhesions in the preconditioned groups than in the control group. CONCLUSION: RIPC directly before performing small bowel anastomosis does not affect anastomotic stability in the early period, as seen in ischemic preconditioning.

A growing number of revisionary and secondary bariatric operations have been performed in recent years, with the number of operations doubling each year at the authors' center. Diagnostics, indications, and most revisionary operations should be performed by an experienced bariatric surgeon. This study was undertaken to evaluate indications and outcomes of revisionary bariatric operations at a specialized center.At the Centre of Obesity and Metabolic Surgery (University of Freiburg, Germany), 100 consecutive revisionary bariatric operations performed between March 2007 and September 2009 were analyzed concerning indications and outcomes.Only 9 of the 100 revisions were due to early complications (30 days after the primary operation). The indication for most revisions was poor weight loss (n = 55). A mean body mass index reduction of 10 points could be achieved in 1 year, which equals a 56% excess weight loss (EWL). No significant difference in weight reduction between restrictive and malabsorptive revisions was observed. Revisions due to implant-related problems also were frequent (n = 25). Laparoscopic revision was possible in 95% of the cases.Insufficient weight loss is the most frequent indication for revisionary bariatric surgery. The surgery can be performed laparoscopically in most cases, and a significant EWL (50%) can be achieved in 1 year if the right revisionary procedure is chosen.

In order to establish less invasive therapies for treatment of excess bodyweight and obesity, a device that is placed endoscopically has been developed that mimics some of the anatomical and enteroendocrine effects of bariatric surgery. The EndoBarrier system (GI Dynamics, Lexington, Massachusetts, USA) is a duodenal–jejunal bypass liner (DJBL) that consists of a 60-cm long, impermeable fluoropolymer sleeve, which is fixed in the duodenal bulb by a nitinol anchor with barbs [1]. Initial clinical studies have revealed consistent efficacy and safety, with adverse effects described as moderate or mild [1–5]. In this case report a duodenal perforation associated with DJBL and its minimally invasive treatment were described. A 49-year-old man received a DJBL. After 4 weeks the patient presented to the emergency department with an acute abdomen. Radiologic imaging revealed free air in the abdomen suggestive of intestinal perforation (●" Fig.1). We decided to approach this complication by a combined endoscopic and laparoscopic procedure (●" Video1). The DJBL was removed endoscopically and thiswas followed by laparoscopic closure of the perforation in the duodenal bulb using a running suture with self-retraining suture material (VLoc; Covidien, Dublin, Ireland; ●" Fig.2). The patient was discharged from hospital 9 days after the surgery. This case demonstrates a serious complication of a DJBL, which was successfully treated by an interdisciplinary team of surgeons and endoscopists. Duodenal perforation is a life-threatening event with overall mortality of approximately 8%, higher in patients with accompanying risk factors [6]. The recently introduced over-the-scope clip (OTSC; Ovesco Endoscopy, Tubingen, Germany) is another option for endoscopic treatment of duodenal perforation [7]. Hereby we strongly recommend the use of minimally invasive treatment in such circumstances to preserve the options for subsequent minimally invasive metabolic surgery and reduce the perioperative risks for the patients [8]. However, if duodenal ulceration or perforation starts to be seen more frequently, the anchorage system of this device will need to be re-evaluated and revised to permit possible implantation proximal to the pylorus.

Laparoscopic sleeve gastrectomy (LSG) is frequently performed as a definitive bariatric procedure today. Quantitative data on the detailed anatomy of the stomach after LSG are yet sparse. Thirty-two multislice computed tomography (MSCT) data sets acquired in 27 LSG patients (22 female, 5 male) with a dedicated examination protocol and post-processing were evaluated for gastric volume, stomach length, sleeve length, antrum length, staple line length, and maximum cross-sectional sleeve area. Obtained parameters were compared to time after surgery, weight loss, and the occurrence of postsurgical regurgitation. Mean gastric volume was 186.5 ± 88.4 ml. Gastric volume correlated significantly with the time interval after surgery. Sleeve sizes of 105.3 ± 30.2 ml during early follow-up confirmed correct primary sizing of the sleeve, whereas marked dilation to 196.8 ± 84.3 ml was found in patients with a follow-up of 6 months and longer (p = 0.038). Sleeve area and staple line length were also positively correlated with time after surgery. No correlation was found between gastric volume and excess weight loss. In ten patients an intrathoracic migration of the staple line could be noted, with four of these patients developing persistent regurgitation after LSG. Regurgitation was present in only 2 of 17 patients without sleeve herniation. Multislice computed tomography allows for a comprehensive and quantitative evaluation of the anatomy after LSG and thus provides new insights in the process of sleeve dilation. Intrathoracic migration of the staple line could be identified as a possible cause of persistent regurgitation.

Laparoscopic pancreatic surgery is ambitious and should only be performed in institutions with expert knowledge in pancreatic surgery. Whereas pancreatic tail resection is routinely and safely performed in several institutions, the laparoscopic resection of the pancreatic head is only performed by a handful of surgeons. In this article, we present our hybrid approach with complete laparoscopic pylorus-preserving pancreatic head resection and successive reconstruction via a small retrieval incision, which might combine the advantages of the laparoscopic resection with the safety of an open and routine pancreatic anastomosis.

Insufficient weight loss or persistent abdominal complaints are reasons for revisionary operations in bariatric surgery. The selection of the secondary procedure is influenced by clinical and by patho-anatomical factors like the size of the gastric pouch. The purpose of this study was to evaluate multi-slice computed tomography (MSCT)-based volumetric assessment of gastric pouches, gastric sleeves, and anastomoses in patients after bariatric surgery. Twenty-six patients after bariatric surgery received abdominal MSCT immediately after oral administration of an ionic contrast agent solution and intravenous administration of buthylscopalamine. Indications were insufficient weight loss after primary operation, persistent upper abdominal complaints, and decline of bariatric analysis and reporting outcomes system (BAROS) score. The gastric volumes, diameter of the gastrojejunostomy, and the proximal part of the Roux limb were measured on volume rendering images and freely angulated reformations. Evaluation of gastric volumes was successful in 25 examinations (96%). The diameters of gastrojejunostomy as well as the dimensions of the Roux limb were evaluable in all cases. After gastric bypass surgery, a pouch volume >30 ml was found in ten, a widening of the gastrojejunostomy in eight, and a dilated Roux limb in six cases. Two patients presented a combination of a wide anastomosis and a strongly dilated Roux limb. Patients after biliopancreatic diversion had gastric volumes between 210 and 840 ml. Other findings were a fistula, an intragastral stenosis, and internal hernias. MSCT allows crucial patho-anatomical measurements and provides helpful information for selecting the appropriate revisionary operation after bariatric surgery.

The receptor tyrosine kinase ErbB2 is an important prognostic marker and therapeutic target in breast cancer. The aim of this study was to investigate the correlation between ErbB2 gene amplification, mRNA and protein expression in a panel of100 patient-derived nude mouse tumor xenografts of different histological origin.Data were obtained using fluorescence in situ hybridization, GenChip expression analysis, immunohistochemistry and enzyme-linked immunosorbent assay (ELISA). Tumors included the following types: urinary bladder, breast, colon, stomach, kidney, liver, lung, melanoma, ovary, pancreas, prostate, uterus/cervix uteri and others.All tumors with high-level ErbB2 gene amplification expressed ErbB2 mRNA at a level10-fold above average and protein at a level20-fold above average (ELISA). Correlation was found between ErbB2 mRNA and protein expression.Based on expression data, cervical, gastric and adenocarcinomas of the lung emerged as new potential indications for ErbB2-directed cancer therapies.