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At least 451 records · Page 25Linked to original sources
PubMed1996

A new device for the treatment of coloproctostomic stricture after double stapling anastomoses.

OBJECTIVE: A new device of staple cutter was developed to evaluate the clinical effect for the treatment of rectal stricture after the double stapling anastomosis. SUMMARY BACKGROUND DATA: The double stapling technique has become an established reconstruction method for patients with low anterior resection. The major complication of anastomotic stricture associated with circular stapling has been reported to be harmful and distressing. Because underlying mechanisms of stricture are not well understood, no prophylactic means have been developed and this results in postoperative dilation still being the only treatment available. Although various dilation methods are used for the treatment of stricture, none is fully satisfactory. METHODS: Low anterior resection was performed in 30 patients with rectal carcinoma using a double stapling technique. First, the incidence of the anastomotic stricture and the clinical factors that contribute to the stricture formation were studied. Second, the clinical effects and advantages of the treatment of coloproctostomic stricture using the newly developed device (staple cutter) were evaluated. RESULTS: Nine (30%) of 30 patients had anastomotic stricture with the symptom of distressing frequent bowel movement. There was no significant relation between the clinical factors and the stricture when compared with that of nonstricture patients. Excellent dilation was performed in all of the nine strictures using the staple cutter, and the symptom of stricture disappeared dramatically in eight patients (89%) within 1 week. The recurrence of stricture occurred in two patients; however, it has not been observed after one further use of this treatment. The staple cutter is safe and easy to use even at the bedside, and except for a conventional anoscope, no special equipment, including fluoroscope, was needed. CONCLUSIONS: From the significant effects and advantages, the procedure using staple cutter is recommended highly for the treatment of circular stapling anastomotic stricture of the rectum.

Adult↗
PubMed1996

The two-fire, one-cartridge stapling method using a modified Endo-GIA.

The endoscopic stapler (Endo-GIA) was designed to divide tissue between two triple-stapled lines. The endoscopic surgeon frequently encounters situations where only stapling is required. Kirby described a staple closure method that uses a knifeless Endo-GIA cartridge. This method, although useful, has the problem of the modified Endo-GIA unit locking. Therefore, we devised a new technique for endoscopic stapling that involves two consecutive staplings using one cartridge without cutting. This method requires modification of the Endo-GIA system by removing the safety-lock system. In addition to enabling endoscopic stapling techniques without the risk of locking, the method can effect a significant cost savings.

Endoscopy↗
PubMed1998

Video-assisted thoracic surgery for lung volume reduction surgery.

Lung volume reduction surgery by video thoracoscopy can result in significant improvement in quality of life and pulmonary function for selected patients suffering from severe emphysema. Clinical trials comparing the use of lasers versus staples, unilateral versus bilateral procedures, and video surgery versus mediansternotomy are summarized. Patient selection and patient care issues are addressed. Information gathered from the selection, evaluation, and study of almost 500 patients treated surgically for emphysema at a single institution is summarized.

Endoscopy↗
PubMed1994

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

BACKGROUND: Disagreement continues among several studies as to the relative advantages and disadvantages of stapled versus sutured colorectal anastomoses. METHODS: One hundred and thirteen consecutive patients (48 men and 65 women, mean age: 67 +/- 12 years) were randomized to either hand-sewn (n = 59) or stapled (n = 54) infraperitoneal colorectal anastomosis. Both groups had similar patient demographics except that fewer patients (4 versus 15) had chronic disease (p < 0.02) and were undergoing side-to-end (11 versus 39) and more patients were undergoing end-to-end (37 versus 20) anastomosis in the stapled group (p < 0.001). RESULTS: Overall mortality was 6% (7 of 113 patients), with no difference found between the two types of anastomosis. Fewer anastomotic leaks occurred in the stapled group (11 versus 7), with an a posteriori gamma error of 11%, whereas the other early postoperative complications occurred with similar frequency in the two groups. Nine mishaps occurred in the stapled group. Stapled anastomoses took less time (median, 42 versus 30 minutes) to perform (p < 0.02). At 8 months, two strictures occurred in the hand-sewn group (n = 52) compared with eight strictures in the stapled group (n = 50) (p < 0.001). CONCLUSIONS: It was not possible to prove that lower anastomosis can be achieved with the stapling device. Routine or regular use of stapling instruments for infraperitoneal colorectal anastomosis cannot be advocated because of higher incidence of mishaps and strictures, even though the operation takes less time to perform and anastomotic leakage occurs less often.

Adult↗
PubMed2002

Laparoscopic mesh and staple Burch colposuspension.

Our objective was to describe our experience with laparoscopic Burch colposuspension and to relate our results to traditional open Burch procedures for the treatment of genuine stress incontinence. Retrospective case series were compared to historical controls. Forty-six women found to have only genuine stress incontinence by history, examination and clinical urodynamics, underwent a mesh and staple laparoscopic Burch procedure. Follow-up ranged from 3 to 50 months. Thirty-seven women were dry, 6 were improved and 3 showed no improvement. This compared to between 75% and 90% of women cured of stress incontinence by the traditional open Burch procedure. We concluded that the results of a mesh and staple laparoscopic Burch procedure in a carefully selected population of women with genuine stress incontinence appears comparable to that reported in the literature for an open Burch procedure.

Female↗
PubMed2005

Bursting strength with various methods of renal artery ligation and potential mechanisms of failure.

BACKGROUND AND PURPOSE: Vascular control is crucial during laparoscopic ligation of the renal vessels. Intracorporeal suture ligation has been replaced by easier methods, such as specialized clip appliers and automatic stapling devices; nevertheless, the optimal application and margin of safety of such devices have yet to be determined. We sought to address this question by measuring the bursting strength of arteries ligated with several standard devices. MATERIALS AND METHODS: One end of an adult porcine artery (3-7-mm diameter) was occluded with a titanium clip, self-locking polymer clip, or laparoscopic linear cutting stapler. Comparisons were made with one or two clips and with different distal cuff lengths (i.e., flush or 2 mm). The open end was secured to a pulsatile infusion pump. Leak/failure pressures were measured using a digital barometer. RESULTS: The mean bursting pressures for the clips were above physiologic arterial pressures (1220-1500 mm Hg). However, the vessels closed with the stapler leaked at a lower mean pressure (262 mm Hg). Failure of titanium or self-locking polymer clips was the result of vessel retraction into and behind the clip, while staple- line leakage occurred between individual staples. Bursting pressures with the titanium and self-locking polymer clips was unaffected by the number of clips or length of vascular cuff. CONCLUSIONS: All tested methods of vascular control performed well at physiologic pressures, suggesting that safety is not increased with traditional maneuvers such as additional clips or longer cuff length.

Animals↗
PubMed1997

Laparoscopic resection of posterior gastric leiomyoma.

Laparoscopic gastric surgery is gaining momentum, especially in the treatment of benign disease. Simultaneous endoscopy and laparoscopy allow precise localization of lesions. Because of the stomach's size, mobility, and distensibility, relatively large lesions can be safely excised. Wedge resection for anterior lesions and a transgastric or intragastric approach for posterior lesions are feasible laparoscopically. Two cases of posterior gastric leiomyomas successfully resected laparoscopically are presented. The use of stapling devices greatly facilitates this procedure.

Female↗
PubMed2003

Randomized trial of rubber band ligation vs. stapled hemorrhoidectomy for prolapsed piles.

PURPOSE: The introduction of stapled hemorrhoidectomy may replace local techniques such as rubber band ligation as a first-line treatment for Grade III and small Grade IV piles. We conducted a randomized trial to determine the role of rubber band ligation in the era of stapled hemorrhoidectomy. METHODS: Fifty-five patients with Grade III or small Grade IV hemorrhoids were randomly allocated to either rubber band ligation or stapled hemorrhoidectomy. Patient demographics and procedure-related details were recorded. Follow-up was at two weeks and two and six months to assess complications, symptom relief, incontinence scores, quality of life, and patient satisfaction. RESULTS: Twenty-five patients were randomly assigned to rubber band ligation and 30 to stapled hemorrhoidectomy. The groups were equally matched for age, gender, grade of piles, continence scores, and quality of life. Stapled hemorrhoidectomy was associated with increased pain and analgesia usage at both 2-week and 2-month follow-up (P < 0.001). Rubber band ligation and stapled hemorrhoidectomy were equally effective in controlling symptomatic prolapse, but rubber band ligation was associated with an increased incidence of recurrent bleeding (P = 0.002). There were 6 procedure-related complications in the stapled hemorrhoidectomy group compared with none in the rubber band ligation group (P = 0.027). There was no difference between the two groups in terms of continence scores, patient satisfaction, or quality of life. CONCLUSION: Stapled hemorrhoidectomy is associated with more pain and minor morbidity than rubber band ligation in the treatment of Grade III and small Grade IV piles. However, for those patients who do not want the risk of further intervention procedures, stapled hemorrhoidectomy offers the better chance of a symptomatic cure.

Adult↗
PubMed2005

Safety of laparoscopic intracorporeal rectal transection with double-stapling technique anastomosis.

To assess the feasibility and analyze the short-term outcomes of laparoscopic intracorporeal rectal transection with double-stapling technique anastomosis, a review was performed of a prospective registry of 67 patients who underwent laparoscopic sigmoidectomy and anterior resection with intracorporeal rectal transection and double-stapling technique anastomosis between July 2001 and January 2004. Patients were divided into 3 groups: sigmoid colon/rectosigmoid carcinoma, upper rectal carcinoma, and middle/lower rectal carcinoma. A comparison was made of the short-term outcomes among the groups. The number of cartridges required in bowel transection was significantly increased in patients with middle/lower rectal carcinoma, and significant differences were observed in the length of the first stapler cartridge fired for rectal transection. Furthermore, mean operative time and blood loss were also significantly greater in the middle/lower rectum group; however, complication rates and postoperative course were similar among the 3 groups. No anastomotic leakage was observed. Laparoscopic intracorporeal rectal transection with double-stapling technique anastomosis can be performed safely without increased morbidity or mortality.

Adult↗
PubMed1994

Endoscopic transanal resection (ETAR) of colorectal strictures in stapled anastomoses.

Anastomotic strictures complicating colorectal anastomoses can be difficult to treat. Endoscopic transanal resection (ETAR) using cutting electrocautery has been described for benign and malignant polypoid rectal lesions, but is not a well-recognised method of treating anastomotic strictures. There are possible theoretical risks to limit the effectiveness of this method in stapled anastomoses. We report five patients with stapled colorectal anastomotic strictures all treated successfully without complication by ETAR, and recommend this treatment option.

Anastomosis, Surgical↗