PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Surgical Stapling”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 181 records · Page 10Linked to original sources
PubMed1981

Transthoracic gastric stapling. Effective new surgical approach to morbid obesity.

"There is a consensus that jejunoileal bypass is no longer an acceptable operation for the treatment of morbid obesity because of well-documented serious complications." Over the past 3 years, experience with the gastric stapling procedure has shown it to be a safe and effective operation for the surgical treatment of morbid obesity. The purpose of the operation is to establish a very small proximal gastric reservoir with a tiny outlet for passage of digested food into the distal stomach. By permitting a comfortable intake of only 2 ounces at a time, the procedure affords an average weight loss of 8 pounds per month. At the Naval Regional Medical Center, Oakland, California (NRMC-O), a new approach to gastric stapling using a transthoracic, transdiaphragmatic technique has been initiated. The transthoracic approach offers the following advantages over the transabdominal approach: (1) better and easier exposure, (2) less chance of splenic injury, (3) a thinner layer of subcutaneous fat through which to dissect, (4) decreased problem with postoperative ileus, and (5) decreased incidence of wound infection and dehiscence. Twenty patients have undergone this procedure at NRMC-O over the past 16 months with no significant morbidity and no deaths. Th average operative time is 2 hours and the average hospital stay in 8 days. Beneficial metabolic and endocrine effects of weight loss have been recorded through our computerized data bank. The data confirm that gastric stapling is a safe and effective procedure and that the transthoracic approach offers ease of exposure and minimizes postoperative complications.

Adolescent↗
PubMed1999

Left colon substitution with His' angle following total gastrectomy. Surgical technique using stapling devices.

To resolve the disadvantages of jejunal Roux-en-Y reconstruction following total gastrectomy, we attempted the use of left colon substitution with all anastomoses conducted using mechanical stapling devices. A His' angle was formed to reduce regurgitation esophagitis. About 25 cm of the left colon with the ascending branch of the left colic artery with an adequate blood supply was brought up to the remnant esophagus without tension on the mesentery. The colon graft was interposed between the esophagus and duodenum in an isoperistaltic fashion. Three anastomoses, esophagocolic, duodenocolic and colocolic, were completed with a circular stapling device. An end-to-side esophagocolonostomy was positioned about 3 cm distal from the blind end of the proximal colon stump. The proximal end of the left colon was pexied to the esophagus using 3-4 stitches to make a new His' angle. Gastrointestinal continuity was restored by a side-to-end colonoduodenostomy and an end-to-end colonocolonostomy. Fifteen gastric cancer patients underwent left colon substitution following total gastrectomy. The circular staple used for esophagocolonostomy and colonoduodenostomy was 25 mm in all patients, and for colonocolonostomy was 29 mm in 9 patients and 33 mm in 6 patients. No problems were encountered in any steps of the procedure, and faulty stapling was avoided. Neither anastomotic leakage nor necrosis of the interposed colon segment was seen, nor was late anastomotic stricture, in any patient. Barium radiograms of the interposed colon segment showed that the capacity and passage of the interposed colon were adequate, and regurgitation did not occur. Diet volume was satisfactory and weight loss minimal.

Adult↗
PubMed1983

In-continuity gastrointestinal stapling.

Several surgical procedures have been proposed to interrupt continuity of the gut, without transection, by means of a row of staples. Using the dog, we investigated the functional and histologic results of incontinuity stapling of the gastric antrum, the small intestine, and the colon. After creation of an end antrostomy, ileostomy, or colostomy, a staple line was placed proximal to the stoma (TA 55-4.8 mm staples). Decompression of the bowel proximal to the staple line was accomplished by an enteric anastomosis. Separation of the staple closure was detected by intestinal contents exiting from the stoma. Animals were sacrificed at the time of disruption, and specimens were obtained for histologic examination. Three of five antral closures broke down at a mean of 19.6 days after operation. All five small-bowel staple lines opened at a mean of 12.4 days. Five of five colonic staple lines disrupted 13.0 days postoperatively. The staples pulled through the bowel wall without losing their "B" shaped configuration. Microscopic examination showed intact mucosa across the staple line, with no submucosa to submucosa healing. Staple lines in the undivided small bowel or colon disrupt after approximately two weeks, due to lack of fibrotic healing. Staple interruptions of the gastric antrum also disrupt, but with less regularity.

Animals↗
PubMed2003

Ambulatory stapled haemorrhoidectomy: a safe and feasible surgical technique.

OBJECTIVE: To compare outcomes following stapled haemorrhoidectomy as an in-patient versus day-surgery procedure. DESIGN: Prospective non-randomised study. SETTING: University affiliated hospitals, Hong Kong. SUBJECTS AND METHODS: Forty-eight consecutive patients who underwent stapled haemorrhoidectomy were included in the study. Twenty-four patients had the procedure in an ambulatory setting and the other 24 were treated as in-patients. The symptoms, operative details, postoperative complications, length of hospital stay, pain scores, analgesic requirements, and patient satisfaction scores were collected. Comparison was made between those patients undergoing ambulatory surgery and those treated as in-patients. RESULTS: There were 25 women and 23 men in the study. The mean age was 46.6 years (standard deviation, 12.1 years). The mean operating time was 29.3 minutes (standard deviation, 9.9 minutes). An incomplete 'doughnut' after stapling was found in one patient. There were no other adverse intra-operative events or complications. Postoperative morbidities occurred in eight patients but none required further surgery. One patient in the day-surgery group could not be discharged because of urinary retention and three required re-admission to hospital because of secondary haemorrhage (n=1) or fever (n=2). There were no differences in the postoperative complications, pain scores, analgesic requirements, and patient satisfaction scores between the two groups. The total mean hospital stay was significantly shorter for those undergoing day-surgery stapled haemorrhoidectomy (0.46 versus 1.9 days, P<0.01). The mean follow-up period was 4.6 months (standard deviation, 4.0 months). All patients reported symptomatic improvement during this time and there was no incidence of faecal incontinence. One patient had a soft stricture, one had a fissure, and two had residual skin tags. All of these problems were conservatively managed, without the need for further surgical procedures. CONCLUSIONS: Stapled haemorrhoidectomy is a safe and effective operation for haemorrhoids. It is a feasible procedure to perform as day-surgery. The hospital stay can be significantly shortened, thus reducing the costs associated with in-patient care.

Ambulatory Surgical Procedures↗
PubMed2006

Comparison of holding power of metal and absorbable hemostatic clips.

PURPOSE: Metal hemoclips remain in the tissue permanently. Metal clips will interfere with the interpretation of a computed tomography or magnetic resonance imaging scan. Polydixanone polymer clips (Absolak extra clips; Ethicon Endo-Surgery, Cincinnati, OH) are completely absorbable. Absolak extra clips will not interfere with a computed tomography or magnetic resonance imaging scan and will encircle 360 degrees vessels for extra security. The aim of this study was to test the holding strength of the metal hemoclips and Absolak clips and the amount of pressure that will cause slippage of the 2 types of clips. METHODS: The study period was from April 2001 to December 2002 and the study included 74 patients undergoing colectomy. There were 40 men and 34 women. Patient ages ranged from 33 to 86 years (average, 64.5 y). The clips were applied on the dissected vessels of the specimen. Part I of the study was as follows: a rubber band was applied to the protruding part of the clip and a balance weight then was tied onto the rubber band. The weight was increased gradually by 50-g units. The weight that caused slippage of the clip was recorded. Part II of the study was as follows: a correctly sized angiocatheter was inserted individually into the artery and vein and attached to a sphygmomanometer. The intravascular pressure was increased by inflating the balloon of sphygmomanometer and the amount of pressure that caused slippage of the clips was recorded. RESULTS: Part I of the study determined that an artery could hold 406.4 +/- 46.1 g, a vein could hold 247.3 +/- 36.5 g, and both arteries and veins could hold 621.6 +/- 24.9 g without slippage when a single hemoclip was applied. No slippage occurred when an Absolak or double hemoclips were applied to the vessel(s). Part II of the study determined that a hemoclip would slip off of a vein when the pressure was increased to 156.6 +/- 8.4 mm Hg. Double clips would slip off of a vein when the pressure was increased to 257.6 +/- 9.6 mm Hg. No hemoclip slipped off of an artery after application even if the amount of pressure was increased to 300 mm Hg. No Absolak clip slipped off after application to an artery or vein even if the amount of pressure was increased to 300 mm Hg. CONCLUSIONS: Absolak clips can withstand a higher weight than single hemoclips without slipping off of an artery and/or vein. Likewise, Absolak clips can withstand a higher intravascular pressure without slippage than single or double hemoclips when applied to a vein.

Adult↗
PubMed2006

Incidental splenic artery aneurysm during laparoscopic gastric banding.

Splenic artery aneurysm occurs in approximately 1% of the population, and is four times more common in females. Women with a history of multiple pregnancies carry the highest risk. These aneurysms are usually incidental findings. Rupture carries a substantial mortality. Management choices include open, laparoscopic, and endovascular procedures. We report a 44-year-old female with a BMI of 56 who underwent laparoscopic gastric banding. Upon exploring the abdomen, a 4-cm splenic artery aneurysm was discovered. The aneurysm was excluded by proximal and distal surgical clips. The patient's postoperative course was unremarkable. This surgical technique is simple, safe, minimally invasive, and provides adequate therapy without incurring the morbidity associated with aneurysmectomy and splenectomy. It is likely that this problem will be encountered again by bariatric surgeons, because this area is commonly exposed. Therefore, this is something that bariatric surgeons should be aware of, be able to recognize, and understand the various therapeutic options.

Adult↗
PubMed2001

Circular stapling procedure for mucosal prolapse of the rectum associated with outlet obstruction.

The aim of this study was designed to investigate the outcome from using the new circular stapling device in the surgical treatment for mucosal prolapse of the rectum associated with outlet obstruction. The treatment consisted of resection of the mucosal prolapse through a transverse incision and resecting a suitable part of the mucosa between the rectum and the anal canal, using an HCS33 circular stapler. Eleven patients successfully underwent this operation without morbidity or mortality, and were assessed clinically and by rectoanal manometry and defecography pre- and post-operation. The mean operating time was 39 (range 22-49) min. The postoperative proctalgia and complications were mild, and the patients were discharged at 4 days after the operation. The pre-operative constipation was improved, and the patient's satisfaction was increased at one month after operation in comparison with the preoperative level. Rectoanal function test at 6 months after the operation demonstrated normalization of the maximum resting and squeezing pressures of the anal canal and rectal compliance to the normal levels. No patient has had recurrence of symptoms during the follow-up period. Our data suggest that this procedure may be a useful surgical treatment, as it causes little postoperative complication and enables early discharge of the patients. However, long-term outcomes of recurrence, continence, and constipation need to be evaluated in a more extended follow-up.

Female↗
PubMed1999

A national survey of thoracic surgical practice in the UK.

We conducted a survey of thoracic surgery in the UK today. Questionnaires were sent to 75 cardiothoracic surgeons, known to perform thoracic surgery regularly; we had a 100% response. The commonest preoperative investigations for carcinoma of the oesophagus were serum alkaline phosphatase (90%), GGT (69%), contrast swallow (80%), ultrasound of abdomen (71%) and CT scan of chest and abdomen (60%). After oesophagectomy, 84% of the surgeons inserted nasogastric tubes and 31% sent their patients to the intensive care unit. Oral fluids were started on days 3-5 in 81% of cases, and 58% of the surgeons requested a postoperative contrast swallow, usually between the seventh and tenth postoperative days, after oral fluids had been started. Most of the surgeons nearly always used staplers for a given procedure or else completely avoided them for that part of the operation. The commonest use of staplers was for bronchial closure in pneumonectomy (67%) and lobectomy (48%) and in constructing an oesophageal anastomosis (25%). Twenty per cent of the surgeons did not insert a chest drain after pneumonectomy, while 65% observed the protocol of chest drain insertion with short intermittent unclamping, usually every hour, followed by removal of the drain, usually the next morning. Thoracic surgeons vary widely in their surgical practices. In a well structured training programme, trainees should rotate between several units so they are exposed to different techniques and ideas and acquire a broad based training.

Chest Tubes↗
PubMed2000

The history of thoracic surgical instruments and instrumentation.

Thoracic surgical practice has evolved from the innovations of its pioneers. Beginning with the stethoscope discovered by Laënnec with his system of auscultation, to the tools we use in the dissection and control of the hilum of the lung for resection, our practice of thoracic surgery has been entwined with the development of instruments and instrumentation. The development of strategies to prevent death from the open pneumothorax began with manual control of the mediastinum and progressed through differential pressure to, finally, the technique of intubation and the methods of positive-pressure and insufflation anesthesia. The instruments we place in our hands are not enough to define our art. Entry into the chest would not be possible without the use of rib retractors, rib shears, and even periosteal elevators. Finally, to the present day of minimally invasive techniques and the application of thoracoscopy for therapeutic purposes, we find the efforts of our predecessors well developed. For the progression from the fear of the open pneumothorax to the present-day state of the ease of thoracotomy for lung resection we are indebted to those who gave so much of their time and, for some, their lives to death from tuberculosis, to allow the advancement of our practice of surgery. These great people should be remembered not only for their acceptance of novel ideas but also, more importantly, for their lack of fear of testing them.

Endoscopes↗
PubMedDate not supplied

Jejunal pouch with nerve preservation and interposition after total gastrectomy.

BACKGROUND/AIMS: In this paper, we describe operative technique details and our results with a modified technique for jejunal pouch formation and interposition after total gastrectomy, with an overall aim to achieve results superior to jejunal pouch and Roux-en-Y reconstruction, as reported in the literature. METHODOLOGY: Following total gastrectomy, the jejunum was divided approximately 20 cm distal to the ligament of Treitz. Marginal vessels were not divided in order to preserve the nerves in the 50 cm of distal jejunum which would be used for pouch construction. The pouch was constructed using a linear stapler (Endo GiA, United States Surgical Corp., Norwalk, Conn). A total of 15 gastric cancer patients underwent construction of a nerve-preserving jejunal pouch and interposition following total gastrectomy. RESULTS: None of the patients experienced postoperative complications due to pouch construction. Additionally, discomforts such as dumping or stagnation were not observed. Mild reflux esophagitis occurred in five of the 15 patients and was resolved by oral administration of camostat mesilate. Six months after surgery, the average patient's diet volume and body weight had gradually increased to 79% and 86%, respectively, of the presurgical levels. A dual phase, dual isotope radionucleid pouch emptying study was also performed six months after surgery. The intra-pouch RI retention rate was 47% for liquid food and 53% for solid food 120 minutes after intake. The emptying rate was slower for both solid and liquid food, as compared with healthy individuals. CONCLUSIONS: The pouch-emptying test demonstrated a satisfactory retention capacity and an acceptable emptying time as a gastric substitute. The patients who underwent gastric reconstruction with a nerve-preserving jejunal pouch with interposition have experienced a reasonably good quality of life.

Female↗
PubMed2003

Complications and results after stapled haemorrhoidopexy as a day surgical procedure.

BACKGROUND: The aim of this report is to describe our experience with stapled haemorrhoidopexy as a day surgery procedure. METHODS: From January 2000 to January 2003, a total of 214 patients with third- and fourth-degree haemorrhoids underwent stapled haemorrhoidopexy under spinal anaesthesia. We analysed early postoperative complications and long-term results. Patients were followed for 4-36 months (mean, 22 months). Only 3 patients (1%) were hospitalised. The long-term complications were analysed by means of a mailed questionnaire. RESULTS: Minor bleeding at wiping after defecation was observed by 9% of patients and minor haemorrhoidal prolapse by 8% of patients. Pain after defecation was reported by 6% of patients and anal stenosis occurred in 2% of them. Faecal urgency was reported by 3% of patients with previously unknown incontinence problems. CONCLUSION: According to our experience, stapled haemorrhoidopexy can be safely performed as a day surgery procedure.

Ambulatory Surgical Procedures↗