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At least 397 records · Page 22Linked to original sources
PubMed1997

Effect of bovine pericardial strips on air leak after stapled pulmonary resection.

BACKGROUND: Surgical procedures for emphysema have been proposed and in many settings resulted in significant improvement in dyspnea and function. The most prevalent surgical problem in all series is prolonged postoperative air leak. METHODS: One hundred twenty-three patients undergoing stapled thoracoscopic unilateral lung volume reduction operation were prospectively randomized to receive either no buttressing of their staple lines or buttressing of all staple lines with bovine pericardial strips. RESULTS: The two groups were comparable in preoperative risks and in the severity of their emphysema. Postoperative complications were identical in the two groups with respect to pneumonia, empyema, and wound infection; however, there was a significant difference in the duration of postoperative air leaks. Those having the pericardial strips used to buttress their staple lines had chest tubes removed 2.5 days sooner and were discharged from the hospital 2.8 days sooner as a result. The cost data revealed that because of the cost of the pericardial sleeves, the overall hospital charges were almost identical for the two groups ($22,108 bovine, $22,060 no bovine) in spite of the shortened hospital stay. CONCLUSIONS: The use of bovine pericardial sleeves to buttress the staple lines in thoracoscopic unilateral lung volume reduction operation results in a shorter duration of postoperative air leaks. Total hospital charges were comparable in the two groups as the 2.8 days saved in the hospital were offset by the cost of the pericardial sleeves.

Aged↗
PubMedDate not supplied

Laparoscopic vascular control techniques in donor nephrectomy: Effects on vessel length.

BACKGROUND: Various techniques for vascular control have been used during urologic laparoscopic procedures. The importance of optimizing the vessel length and securing reliable vascular control are critical for procedures like laparoscopic donor nephrectomy. We aimed to determine the length of vessel lost by using 4 common techniques of vascular control in a fresh human cadaveric vascular model. METHODS: The techniques include application of 2 non-absorbable polymer-ligating clips (10-mm Hem-o-Lok MLX Weck Closure Systems, Research Triangle Park, NC), Endo-GIA II stapler (30-mm length, 2.5-mm staples, Auto Suture, US Surgical, Norwalk, CT), Endopath ETS35 stapler (35 mm length, 2.5mm staples, Ethicon Endo-Surgery), and the Endo Ta-30 stapler (30-mm length, 2.5-mm staples, Auto Suture, US Surgical, Norwalk, CT). RESULTS: The Endo-TA-30 stapler and the polymer clips resulted in significantly less compromise of the vessel length, when compared with the other methods of vascular control. CONCLUSIONS: The Endo-TA-30 stapler and the polymer clips can be applied during laparoscopic procedures where optimizing vascular length is important.

Aorta, Abdominal↗
PubMedDate not supplied

Application of self-expanding metallic stents to malignant stricture following mechanically stapled esophagojejunostomy: report of two cases.

Several types of self-expanding metallic stents (SEMS) were placed in two patients suffering from severe malignant stricture at the site of a mechanically stapled esophagojejunostomy used for the treatment of recurrent gastric cancer. Following modified Gianturco stent placement with limited success in one of the patients, an additional Ultraflex stent (Boston Scientific Co., Boston, USA) failed to expand satisfactorily at the outlet of the second stent. In the other patient, since the proximal end of an additional covered Ultraflex stent (Boston Scientific Co.) inserted through the first one failed to expand satisfactorily at the level of severe stenosis because of the extreme rigidity caused by the mechanical staples, a spiral Z-stent was inserted to dilate it. The cases reported here raise some problems associated with the treatment of severely malignant stricture accompanied by extreme rigidity following mechanically stapled esophagojejunostomy with SEMS.

Anastomosis, Surgical↗
PubMed1994

Methods of controlling presacral bleeding.

Rectal mobilization during abdominoperineal or low anterior resection involves careful dissection between the rectum and the sacrum. Inadvertent manipulation outside the avascular presacral space may damage presacral veins, causing troublesome and potentially life-threatening bleeding. We reviewed the current management of presacral bleeding, including the use of an endoscopic stapling device to control presacral bleeding.

Hemorrhage↗
PubMedDate not supplied

Circular stapling techniques for low anterior resection of rectal carcinoma.

BACKGROUND/AIMS: This report provides our experience in 103 patients with adenocarcinoma of the rectum along with a general overview of the use of circular stapler in rectal surgery. MATERIALS AND METHODS: Forty-two patients were randomized to a rectal anastomosis using either the single (SST) or double stapling technique (DST). RESULTS: From February 1991 to the present, 61 consecutive patients were treated to a rectal anastomosis using the DST. Perioperative mortality was 4.7 percent unrelated to the use of staplers. Statistically significant differences were noted: the mean distal resection margin measured 25.3 mm for SST and 35.0 mm for DST (p = 0.0274), without doughnut rings. Anastomotic stricture occurred in 3 patients (25%) using the 28-mm cartridge and in 1 (1.4%) using the 31-mm cartridge, respectively (p = 0.0082). To evaluate the different stapling techniques with bacterial contamination, the drain fluid was examined for lysozyme activity. When the SST was used, statistically significant enzyme activity increased as compared with the DST. Clinical leaks were noted in 9.5 percent (2/21) of the SST and in 2.4 percent (2/82) of the DST. The median follow-up of patients in the randomized study was 45 months (range, 32-62 months). Of the patients who underwent a potentially curative resection, seven (17.9 percent) developed a local recurrence, with no statistically significant differences in the stapling techniques of local recurrence and overall survival. CONCLUSIONS: Our experience, and that reported in literature, suggests that the double stapling technique is useful for restorative resection of rectal cancers.

Adenocarcinoma↗