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At least 271 records · Page 15Linked to original sources
PubMed2001

Randomized clinical trial of stapled versus Milligan-Morgan haemorrhoidectomy.

BACKGROUND: The introduction of a stapling technique for the treatment of haemorrhoids has the potential for less postoperative pain, a short operating time and an early return to full activity. The outcome of stapled haemorrhoidectomy was compared with that of current standard surgery in a randomized controlled study. METHODS: Two hundred patients were randomized to either stapled haemorrhoidectomy (n = 100) or Milligan-Morgan haemorrhoidectomy (n = 100) between March 1997 and December 1998. Each patient received standardized postoperative analgesic and laxative regimens, and completed a linear analogue pain score every 6 h during the first day after operation, after the first motion and daily until the end of the first week. Operating time, frequency of postoperative analgesic intake, hospital stay, time to return to normal activity and postoperative complications were also recorded. RESULTS: The mean(s.d.) age of patients in the stapled and surgical groups was 44.1(3.2) and 49.1(12.2) years respectively. The stapled group had a shorter operating time, less frequent postoperative analgesia intake, shorter hospital stay and earlier return to normal activity. Early and late complications, and functional outcome were better in the stapled group. CONCLUSION: Use of a circular stapler in the treatment of haemorrhoidal disease was safe, and was associated with fewer complications than conventional haemorrhoidectomy.

Adult↗
PubMed1995

Supraperitoneal colorectal anastomosis: hand-sewn versus circular staples--a controlled clinical trial. French Associations for Surgical Research.

BACKGROUND: Although used widely for supraperitoneal anastomoses, circular stapled anastomoses have never been proved better than hand-sewn anastomoses. In the one prospective controlled trial that studied these anastomoses specifically, the only significant difference found was that there were more clinically obvious leakages with the circular stapled variety, but not in the overall clinical and roentgenologic leakage rates. METHODS: One hundred fifty-nine consecutive patients (88 men and 71 women, mean age 65.8 +/- 12.1 years) were randomized to undergo hand-sewn (n = 74) or circular stapled (n = 85) supraperitoneal colorectal anastomosis after left colectomy. RESULTS: Patient demographics were similar in both groups. Overall mortality was 1.3% (2 of 159; one in each group). No statistically significant difference (NS) was found in the rate of early complications, including anastomotic leakage (4 of 74 versus 6 of 85) in the hand-sewn and stapled anastomoses, respectively). Mishaps (n = 10) and hemorrhage (n = 5) occurred in the stapled group only. Stapled anastomoses took an average of 8 minutes less to perform (p < 0.001), but this time gain did not significantly influence the overall duration of operation (identical median times). The median duration of hospitalization was 13 and 14 days, respectively (NS). At 8 months there were 2 of 74 strictures in the hand-sewn group and 4 of 85 strictures in the stapled group (NS). CONCLUSIONS: According to these results, there seems to be no advantage of routine or regular use of stapling instruments for supraperitoneal colorectal anastomosis.

Adult↗
PubMed1999

Favorable scanning electron microscopic findings of stapled saphenous vein-carotid artery anastomoses.

BACKGROUND: In the progress toward "off-pump" endoscopic coronary artery surgical procedures, new techniques for coronary artery anastomoses are being developed. One such approach is the use of nonpenetrating titanium clips. We evaluated the quality of anastomoses achieved using this technique in a porcine model of saphenous vein-carotid artery grafting using scanning electron microscopy. METHODS: Bilateral saphenous vein-carotid artery interposition grafts were implanted in 10 "white race" pigs, using the nonpenetrating clips in one side of the neck and conventional hand suturing on the opposite side. One week after operation, the grafts were harvested. RESULTS: All grafts were patent 7 days after operation, and 40 anastomoses underwent scanning electron microscopic study. In all samples, the luminal surfaces of both the carotid artery and vein graft were covered by a continuous layer of endothelial cells up to the anastomosis. Anastomotic sites in all clipped samples and most of the sutured anastomoses were completely endothelialized, and anastomotic clefts were indistinguishable. However, in 25% of sutured specimens, the suture material remained clearly visible inside the lumen of the vessel, and the subendothelial matrix remained exposed, with extensive fibrin, red blood cells, and platelet deposition on its surface. CONCLUSIONS: Because the endothelial coverage consistently appeared to be complete and the subendothelial matrix was not exposed, it is likely that the risk of early anastomotic thrombosis is reduced by using the nonpenetrating titanium clips.

Anastomosis, Surgical↗