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Clinical application of a nonpenetrating microvascular stapling device for vascularized free tissue transfer.

It is essential to develop a method that is technically easier and faster to perform microvascular anastomosis. Therefore the authors have utilized a nonpenetrating microvascular stapling device (VCS; Auto Suture, Tokyo, Japan). Eight vascularized free tissue transfers were performed using this stapling device. All of the transferred tissues were grafted successfully. The time required to perform the stapled microvascular anastomosis ranged from 8 to 18 minutes (mean, 12 minutes). Two arterial anastomoses required suture repairs because they could not be repaired with the use of this stapling device due to thickened vessel walls and intimal dissections. The microvascular stapling device proved useful for vascularized free tissue transfers, but the vessels suitable for this technique should be chosen carefully. Not only the surgeon but also the assistant must be experienced in microscopic surgery.

Adult↗

A prospective randomized study comparing stapled with handsewn oesophagogastric anastomoses.

One hundred patients with carcinoma of the distal oesophagus or gastric cardia undergoing oesophagogastrectomy were randomized to receive either a stapled or handsewn oesophagogastric anastomosis. Five patients died in the early post-operative period at a mean of 16 days (in-hospital mortality 5%) allowing detailed follow up on the remaining 95 patients who were followed up to death or for a minimum of 36 months. A stapled anastomosis was quicker to perform (P < 0.001), resulting in a shorter operative time (P < 0.005) and was associated with decreased blood loss (P < 0.05). The number of anastomotic leaks, length of in-patient stay, stricture formation and survival in the two groups was not statistically different. A stapled oesophagogastric anastomosis fulfills all of the requirements for routine use in thoracic surgical practice when performing oesophageal resection for carcinoma of the distal oesophagus or gastric cardia. It is quick to perform allowing a shorter operating time and lower blood loss and does not appear to be associated with a previously noted increased incidence of benign anastomotic stricture formation when compared with handsewn anastomoses.

Aged↗

Stapled hemorrhoidectomy.

The procedure of stapled hemorrhoidectomy has been established as a safe and effective method for treating symptomatic hemorrhoids not responsive to more conservative measures. This chapter discusses the issues of safety, efficacy, durability, and cost of this procedure. In addition, we outline techniques for performing the procedure safely and effectively.

Digestive System Surgical Procedures↗

Anastomotic technique and survival after right hemicolectomy for colorectal cancer.

AIM: To compare the long-term outcome of patients after right hemicolectomy for colorectal cancer undergoing ileocolonic reconstruction either by a sutured technique or by side-to-side stapled anastomosis. METHODS: Single surgeon series from 1992 to 2001 comprising 100 consecutive patients, 59 with hand sutured reconstruction and 41 undergoing TLC 55mm stapled side-to-side anastomosis. Details of gender, patient age, and elective versus emergency presentation, Dukes stage, and curative versus palliative resection were recorded prospectively. In addition, post-operative hospital stay and subsequent survival were determined by prospective protocol follow-up. RESULTS: Overall 24% of the patients studied presented as emergencies and underwent a palliative procedure. There were no anastomotic leaks in either the stapled or sutured groups. Hospital mortality was also not significantly different--stapled reconstruction, 7%, sutured reconstruction, 10% (p value 0.624). Overall long-term cancer outcome was the same for both anastomotic techniques, both stapled and sutured groups having a median survival of 2.9 years. CONCLUSIONS: Stapled ileocolonic reconstruction after right hemicolectomy for colonic carcinoma is a safe and reliable surgical technique associated with long-term cancer outcomes comparable with those obtained by the sutured anastomotic technique.

Adenocarcinoma↗

[Rectal stenosis after stapler hemorrhoidopexy].

We report a case of a 52-year-old woman with hemorrhoids submitted to Procedure for Prolapse and Hemorrhoids (PPH), i.e. stapled hemorrhoidopexy, using a modified Longo's technique (double purse string) to treat an associated rectocele and rectal prolapse; the STARR technique (Stapled Trans Anal Rectal Resection) was not yet codified. The post-operative course was uneventful and the patient is discharged in II p.o. day. In fifth post-operative day the patient came back with an unusual rectal stenosis due to the superior purse string. The stricture was easily resolved by 'opening' the purse string with a transanal approach in outpatient setting.

Constriction, Pathologic↗