Forschung in der Chirurgie

Stelzner, F.

doi:10.1007/s00104-010-1920-8

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Chirurg

2010

DOI: 10.1007/s00104-010-1920-8

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Forschung in der Chirurgie

F. Stelzner

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Cited by 4 publications

(3 citation statements)

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“…Before guidelines became fashionable and professional values appeared as statements on every hospital website, he conveyed an attitude of ethics and devotion to our profession. His lifelong strife for critical thinking and intelligent thought [29] into everyday surgery led the way to independence in personal developments of his staff members and students.…”

mentioning

confidence: 99%

“…His awareness of his position and his development as a surgeon led him to philosophical excursions about the development of a surgeon and how fortunate he was with his own career [20,32]. Reflections on history of surgery and the development of opinions accompanied him during his long career [21,29,33]. And he had no fear to stand out and raise his voice in cases where he thought a look into history might be helpful [9,11,14].…”

mentioning

confidence: 99%

“…He also raised our attention to useless or unnecessary surgery and activity. He called it "symbolic surgery" [9,29,34]. Procedures we adopted from our forefathers without sufficient proof of their viability were always a topic for re-thinking.…”

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confidence: 99%

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Ninety and still active in research

Dahl

Giebel²

2012

Langenbecks Arch Surg

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His efforts in comparative anatomy and morphology are commended. An open mind throughout his life with sharp scientific reasoning opened him a world of solid arguments based on evidence to prove his view, sometimes after decades. Exemplary are the discussions about the adenoma-carcinoma sequence or his views on anatomical structures limiting the spread of cancer cells. We note his continuing research activities well beyond normal pension age. At the age of over 90, he is still a very sought-after conference speaker.

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confidence: 99%

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confidence: 99%

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Ninety and still active in research

Dahl

Giebel²

2012

Langenbecks Arch Surg

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Dehnverschluss der Speiseröhre

Stelzner¹

2014

Chirurg

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The investigations described in this article clearly show that the lower esophageal sphincter (LES) represents a variation of circular muscular occlusive mechanisms found elsewhere in the gastrointestinal tract. The LES is a double layer stretch sphincter that operates in an apparently paradoxical manner: it closes when under stretch but opens when the muscle fibers contract. Impedance manometry studies demonstrate that the entire esophagus is involved in the normal functioning of the esophagus as well as in esophageal disorders. The pronounced elasticity of esophageal tissue is a functional feature that has its basis in the singular architecture of elastic fibers located between the muscle layers. All traditional forms of operative treatment of gastroesophageal reflux disease (GERD) impede the natural functioning of the stretch sphincter to a greater or lesser degree by locking it up. The cause of GERD is mainly by contraction of the esophagus brought about by the cephalad transposition of the stretch sphincter segment into the chest. In a sense this is an incipient axial hernia that frequently remains undiagnosed in the early stages. The operative repositioning of the stretch sphincter segment into the abdominal cavity provides sufficient restoration of the natural topographic relationships to achieve a cure of GERD. Whether this straightforward repair restores the function of the entire esophagus remains to be elucidated. The concept of the stretch provides a good explanation of the pathophysiology of achalasia, a condition in which a paralyzed paradoxical ring sphincter remains occluded. Successful myotomy approaches only split the muscularis propria layer of the stretch sphincter while leaving subepithelial muscle fibers intact that remain paralyzed. This limited intervention provides a good relief of symptoms.

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Paradoxe Sphinkteren im Abdomen

Stelzner

2015

Chirurg

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Nitric oxide molecules serve as neurotransmitters to relax smooth muscle tension in many parts of the body. In humans and other mammals they play an important role for correct smooth muscle function in unusual locations. We previously described this mechanism (Stelzner, Chirurg. doi:10.1007/s00104-014-2777-z, 2014) using the occlusive mechanism of the upper and lower esophageal sphincters as an example. Cells producing nitric oxide can be found in the gastric fundus, the anorectal continence organ, vesicourethraltract and also in the uterine cervix in the final trimester of pregnancy. In all these locations they serve as elements of anatomical sphincter structures that have a paradoxical function. These observations confirm the points made in the introduction of this article on the stretch sphincter mechanism of the lower esophageal sphincter and the treatment of gastroesophageal reflux disease by retensioning of the esophagus in the diaphragmatic hiatus. In particular, high-resolution esophageal manometry of the lower esophageal sphincter can easily detect every functional disturbance caused by gastric plication and such changes were to be expected based on what we described in articles I and II.

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Forschung in der Chirurgie

Cited by 4 publications

References 5 publications

Ninety and still active in research

Ninety and still active in research

Dehnverschluss der Speiseröhre

Paradoxe Sphinkteren im Abdomen

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