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At least 235 records · Page 13Linked to original sources
PubMed1996

Early detection of anastomotic leaks after low anterior resection of the rectum.

PURPOSE: Lysozyme destroys the mucopolysaccharide chains of the cell wall of gram-negative bacteria. It is a component of local defense and is formed in macrophages. Determination of lysozyme content in the wound seems to be the most reliable method for early recognition of wound infection. METHODS: In a prospective randomized study on the efficacy of single vs. double staple technique in anterior rectum resection, the effluent from the pelvic drain was examined with regard to its lysozyme activity. RESULTS: Lysozyme activity in drained secretion remained stable for more than 24 hours at room temperature. When the single staple technique was used, enzyme activity was sharply increased (mean, 9.6 mg/dl on the first postoperative day) compared with the double staple technique (mean, 5.5 mg/dl on the first postoperative day). The difference was statistically significant (P < 0.0001). Mean lysozyme activity was increased in those patients with clinically (18 mg/dl on the first postoperative day) and radiologically (15.3 mg/dl on the first postoperative day) detected dehiscence (P < 0.0001). CONCLUSION: Lysozyme determination may be reproduced by detection of enzyme stability in drained secretion. Determination of lysozyme content seems to be a new possibility for early recognition of anastomotic dehiscence.

Aged↗
PubMed2002

Five-year results of laparoscopic vertical banded gastroplasty in the treatment of massive obesity.

BACKGROUND: Laparoscopic surgery appears to offer rapid recovery and low postoperative morbidity. The aim of the present study was to assess the outcome of laparoscopic vertical banded gastroplasty (LVBG) in 154 obese patients with a follow-up of 12-60 months. PATIENTS AND METHODS: 154 massively obese patients (132 female) with a mean +/- SEM body mass index (BMI) of 43.4 +/- 0.6 kg/m2 were followed prospectively for an average of 31.7 +/- 1.4 months. LVBG was performed using 5 trocars placed in a standard fashion for laparoscopic upper gastrointestinal surgery. A 4-row stapler was used for the vertical staple-line and a stretched polytetrafluoroethylene (Gore-tex) band was used to reinforce the outlet. After the first 67 cases, the procedure was altered so that a 5-cm length was marked on the band. RESULTS: Conversion to open surgery was performed in 33 cases. All patients lost weight. At 60 months follow-up, the postoperative weight was similar in the open and laparoscopic group.The subjects where 5 cm length was marked on the band had a significantly better weight loss at 36 months (30.4 +/- 1.2). Both early (< 1 month postoperative) and late (> 1 month postoperative) complications were more common in the group converted to open surgery. Postoperative stay was shorter in the laparoscopic group. CONCLUSIONS: LVBG can be performed safely and results in shorter postoperative stay than open VBG. With adherence to surgical technique (5-cm band circumference), weight-loss is maintained at an adequate level. Complications after LVBG do not exceed open VBG.

Adult↗
PubMed1999

Obesity: an innately incurable disease?

BACKGROUND: Staple-line disruption is a common complication after vertical banded gastroplasty (VBG). METHODS: Of 655 patients who underwent VBG, a hole across the partition developed in 46 (7.02%). RESULTS: The original excellent weight loss from a BMI of 49.2 +/- 6.9 kg/m2 to 31.9 +/- 6.1 kg/m2 stopped with staple-line dehiscence, and all 46 patients regained weight, even to their original weight. After operative revision by restapling (n = 24/46) or implantation of an adjustable band (n = 10/46), patients reduced their body weight once more (to BMI 31.2 +/- 5.9 or 33.8 +/- 5.8). CONCLUSION: Obese patients need the food-intake reducing operations maintained lifelong; the real cause of obesity is not curable until now, and only the main symptom, "overweight," can be improved by therapy.

Body Mass Index↗
PubMed2002

A technique for prevention of port complications after laparoscopic adjustable silicone gastric banding.

BACKGROUND: Laparoscopic adjustable gastric banding is a safe and effective treatment method for morbid obesity. Injection port dislocation, tube perforation and access port infection are generally classified among the minor complications, although they can require a reoperation at the port-site or even at the level of the band which may have to be removed. We designed a technique to fix the port, that can avoid unnecessary complications. METHODS: The port is sutured onto a polyprophlene mesh, which is then cut into shape and attached to the rectus fascia in the left hypochondrium with a Tacker stapling device. From February 2000 to January 2001, 25 patients (BMI 35-60) were operated using this technique. RESULTS: No injection port dislocation, tube perforation or access port infection has been found in these patients. CONCLUSION: With the larger surface area by which the port is attached to the fascia, a stable position of the port is obtained and dislocation avoided. Multiple failed attempts at port access, with resulting risk of infection, are avoided. Due to port stability, risk of incidental tube perforation is reduced. Moreover, a considerable gain of time is obtained compared with the classical suturing of the port.

Bandages↗
PubMed1998

Primary anastomosis in the treatment of acute disease of the unprepared left colon.

Between June 1, 1990 and December 31, 1996, 58 consecutive patients with unprepared colons were urgently explored for nontraumatic disease with intent to proceed with primary left-sided colonic anastomosis. Unprotected anastomoses were not attempted in 15 patients. The causes of exclusion included preoperative and intraoperative shock in three patients, and three patients were on long-term high-dose steroids, four had gross fecal contamination of the peritoneal cavity, four had large pelvic abscesses, and one had ischemic colitis. All 43 patients undergoing anastomosis without protective colostomy had stapled anastomoses. Indications included complicated diverticular disease in 32 cases. There were nine cases of obstruction from colorectal carcinoma and one obstruction due to sigmoid volvulus. There was one case of perforation from pseudomembranous enterocolitis. The most common complications were: atelectasis in nine cases, wound infection in two cases, and prolonged ileus in two cases. Pelvic abscess occurred in one case. There was one wound dehiscence. There was one anastomotic dehiscence, and there was no mortality. Operative time averaged 85 minutes and hospital length of stay 9.7 days. Primary anastomosis of the unprepared left colon is safe in most urgent and emergent situations, thus avoiding the significant morbidity and cost of colostomy closure.

Abdominal Abscess↗
PubMed1997

Staple disruption in vertical banded gastroplasty.

BACKGROUND: In earlier studies of vertical banded gastroplasty (VBG), staple-line disruptions (SD) were only reported in a few per cent or less. Two recent studies have shown a significantly higher frequency of SD. To find the true frequency of SD, all patients must be examined regardless of weight outcome. METHODS: 91 consecutive patients were examined by a standardized radiological method at different postoperative intervals ranging from 6 to 48 months. RESULTS: 41 out of 91 patients developed SD. The average diameter of the disruptions was 6 mm (range 2-16 mm). During the first 2 years of follow-up, when at least 31% of the patients had developed SD, there was no significant difference in weight loss between the group with SD and the group without SD. CONCLUSION: SD is an inherent problem of VBG which has been underestimated for a long period of time. An SD frequency of 45% or more within the first few years is not acceptable and changes in the VBG technique must be considered.

Female↗
PubMed1994

Leakage from stapled low anastomosis after total mesorectal excision for carcinoma of the rectum.

Over 14 years 276 patients with rectal cancer underwent surgery; 219 who underwent low anterior resection of the rectum with total mesorectal excision were studied. There were 24 (11.0 per cent) major anastomotic leaks associated with peritonitis or a pelvic collection and 14 (6.4 per cent) minor leaks that were asymptomatic and detected by contrast enema. All major leaks occurred at an anastomotic height of less than 6 cm (P = 0.08). The abdominoperineal excision rate was 9.1 per cent. Major leaks were associated with failure to defunction in 11 of 62 patients and with a defunctioning colostomy in 13 of 157 (P = 0.03). Of the 24 patients with major leaks seven developed peritonitis, one with a defunctioned anastomosis (P = 0.002), and three died (P = 0.02). Use of the sigmoid colon led to major leakage in seven of 32 patients compared with 17 of 187 when the splenic flexure was employed (P = 0.05). There was no increase in the local recurrence rate but only nine patients with major leakage and a temporary stoma have had these closed. Key technical factors include: a clean dry pelvic cavity, pulsatile colonic blood supply, suction drainage started during closure and mobilization of ample tissue to fill the pelvic space.

Adult↗
PubMed1996

Single and double stapled anastomoses in rectal cancer surgery; a retrospective study on the safety of the technique and its indication.

Low anterior resection is commonly believed the main indication to double stapled (DS) technique, because placing the purse-string suture on the distal rectum is difficult or impossible. This study was designed to figure out the safety of the DS technique and to better define its role in rectal cancer surgery. The data of 34 patients that had a DS anastomosis were retrospectively compared to those of 43 that had a single-stapled (SS) anastomosis after anterior resection. Three deaths after SS (7%) and one after DS procedures (3%) were recorded (p = 0.62). Rates of clinical leaks were 12% (four cases) in the DS group and 14% (six cases) in the SS group (p = 0.41). The mean distance of the rectal tumour from the anal verge was significantly lower for DS (mean = 7.7 cm) respect to SS (mean = 12.7 cm) anastomoses (p < 0.0001) and the blood consumption at surgery was significantly greater in patients that had DS (mean = 375 ml) compared to SS-anastomoses (mean = 180 ml) (p = 0.028). Thus, the DS technique was mostly used in patients at high risk for leakage. The study shows that DS technique is a safe and reliable method to perform colorectal anastomosis after anterior resection for cancer. For cancers located in the upper rectum the routine adoption of the DS increases the cost of surgery and does not offer advantages over the SS technique with the exception of making feasible end-to-end mechanical anastomoses involving bowel segments having different diameters.

Aged↗
PubMed2005

Results of revisional operation following vertical banded gastroplasty performed due to morbid obesity--comparison between restoration of vertical banded gastroplasty and conversion of gastric bypass up to three years.

The aim of this study was to analyse incidence and efficacy of revisional surgery for failed vertical banded gastroplasty among 458 patients who underwent primary surgery between 1993 and 2003. Staple line disruption was diagnosed in 29 patients and was an indication for restoration of gastroplasty in 10 cases and a conversion to Roux-en-Y gastric bypass in 19 patients. In two cases of outlet stenosis the band was exchanged to enlarge the collar. In two cases of psychological intolerance of restriction the band was removed because of refusion by patients the conversion to Roux-en-Y gastric bypass. A substantial weight reduction without statistical differences between restoration and conversion group was recognized. In two patients (20%) after restoration and three patients (15.8%) after conversion we observed weight regain (p=0.57). In cases with removed band weight regained up to its value recorded before surgery. In patients with exchanged band weight was under control. No serious complications were observed. We could conclude that patients with weight regain after vertical banded gastroplasty should be offered conversion to Roux-en-Y gastric bypass. When malabsorption is refused, restoration of vertical banded gastroplasty could be also performed. Both of procedures are technically difficult but safe.

Adolescent↗
PubMed2001

Diagnosis and management of a mediastinal leak following radical oesophagectomy.

BACKGROUND: The aim of this study was to evaluate the diagnosis, management and outcome of mediastinal leaks following radical oesophagectomy with a stapled intrathoracic anastomosis. METHODS: Some 291 consecutive patients underwent two-phase subtotal oesophagectomy with gastric interposition for malignancy. Patients with clinical suspicion of a leak were investigated with contrast radiology and flexible upper gastrointestinal endoscopy. RESULTS: Nineteen patients (6.5 per cent) developed a proven mediastinal leak at a median of 8 (range 3-30) days following surgery. Contrast radiology and flexible upper gastrointestinal endoscopy identified that 13 patients had an isolated leak from the oesophagogastric anastomosis and two had widespread leakage secondary to gastrotomy-line dehiscence. Endoscopy revealed a further four patients with gastric necrosis in whom contrast radiology was normal. In six patients the diagnosis of leakage followed an apparently normal routine contrast examination on day 5-8. All 13 isolated anastomotic leaks were managed non-operatively with targeted mediastinal drainage, intravenous antibiotics and antifungal therapy, nasogastric decompression and enteral nutrition; the mortality rate was 15 per cent (two of 13). Patients with gastrotomy dehiscence or gastric necrosis had a more severe clinical picture; they were managed with repeat thoracotomy and either revision of the conduit or resection and exclusion. Despite early intervention four of the six patients died. CONCLUSION: Routine postoperative contrast radiology cannot be recommended. On clinical suspicion of a leak patients require both contrast radiology and endoscopic evaluation. Isolated anastomotic leaks can be managed successfully with non-operative treatment, whereas more extensive leaks from the gastric conduit require revisional surgery which carries a high mortality rate.

Aged↗
PubMed2000

Nonpenetrating vascular clips for small-caliber anastomosis.

In the search for better anastomosing techniques, an improved vascular stapler device (VCS clip applier system(R)) has been introduced. The system uses nonpenetrating clips to approximate everted vessel walls. The objective of this study was to determine the effects of nonpenetrating vascular clips on endothelial wound healing. Aortic end-to-end anastomoses were performed in male Wistar rats. A comparison was made between clipped (n = 12) and conventional hand-sewn (n = 6) anastomoses. Patency rates were verified at different time intervals (after 1, 4, and 8 weeks), after which the anastomotic sites were removed. Morphological evaluation was carried out using scanning electron microscopy. All rats survived the procedure. Closure with clips took less time than closure with conventional sutures, with decreasing aortic clamping times for the clipped procedures during the course of the experiments. Patency rates were 100% in both the "clipped" and "sutured" groups. Microscopic examination showed favorable endothelial healing at the clipped anastomotic sites, with less inflammatory reaction at 1 week, and a more complete endothelial regeneration at 4 and 8 weeks follow-up, as compared with the sutured anastomoses. The clip applier holds the promise of a useful device in anastomosing small-caliber vessels, since clip closure takes less time than suturing, while patency rates are identical, and morphological results are favorable. Training is mandatory to obtain technical skills and to achieve optimal results.

Anastomosis, Surgical↗
PubMed2005

Vascular closure stapler clips versus polypropylene sutures in end-to-end anastomoses of growing arteries and veins.

Alternatives are still being sought in vascular surgery to avoid the complications caused in growing vessels by the various suture techniques and materials currently in use. A major complication is arrested growth following anastomosis. Opinions differ widely regarding the best approach to this problem, and research is currently underway at our center on the latest generation of clip appliers (vascular closure stapler, or VCS) and their potential application as an alternative to the conventional suture technique in pediatric vascular surgery. This study compared vascular growth and reendothelialization following anastomosis of growing arteries and veins using VCS clips versus the conventional interrupted polypropylene suture technique. Thirty 55-day-old lambs underwent end-to-end anastomosis of the carotid artery and jugular vein. Serial ultrasonography and angiography were carried out over the ensuing 6-month growth period, after which the lambs were euthanized. Gross examination of the anastomosis site was followed by histologic examination involving light microscopy, immunohistochemical techniques, and transmission electron microscopy. Although both VCS clips and polypropylene sutures allowed transverse vessel growth, the clips did not penetrate the intima and thus provided enhanced reendothelialization. The satisfactory results obtained here, as in earlier studies, increasingly point to VCS clips as the method of choice in pediatric vascular surgery.

Anastomosis, Surgical↗