[Comparison of surgical therapy (pneumonectomy and thoracoscopic stapled lung reduction) in pulmonary emphysema].
Explore the source record for details and available documents.
Aged↗
SEARCH · PubMed Health
Results for “Surgical Stapling”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Stapled vs excision hemorrhoidectomy: long-term results of a prospective randomized trial.
HYPOTHESIS: Stapled hemorrhoidectomy offers several advantages over excision hemorrhoidectomy, including reduced postoperative pain, a reduced hospital stay, and an earlier recovery time. Furthermore, stapled hemorrhoidectomy is associated with lower hemorrhoidal recurrence on long-term follow-up. DESIGN: A randomized prospective trial. Patients were blinded to the operation technique used. Follow-up occurred at 1 and 3 weeks and 12 months postoperatively. SETTING: A university hospital providing primary, secondary, and tertiary care. PATIENTS: Forty patients with second- and third-degree hemorrhoid disease were randomized to undergo either stapled or excision hemorrhoidectomy. Two patients were excluded. All patients were subject to a follow-up examination. INTERVENTIONS: Stapled hemorrhoidectomy (Longo technique) vs excision hemorrhoidectomy (Ferguson technique). MAIN OUTCOME MEASURES: Operating time, postoperative pain (measured by the visual analog scale), hospital stay, histologic features, morbidity, defecation habit, continence, recovery time (return to work), and hemorrhoid recurrence at 1 year. RESULTS: Stapled vs excision hemorrhoidectomy was associated with a significantly reduced operating time (30 vs 43.25 minutes; P<.001), reduced postoperative pain scores (visual analog score) on the first 4 postoperative days (day 1: 2.7 vs 6.3; day 2: 1.7 vs 6.3; day 3: 0.8 vs 5.4; and day 4: 0.5 vs 4.8, where 0 indicates no pain, and 10, maximum pain; P < or = .001), and an earlier return to work (6.7 vs 20.7 days;P =.001). There were no differences for stapled vs excision hemorrhoidectomy in length of hospital stay (2.4 vs 2.1 days), complications (3 [15%] of 20 patients vs 5 [25%] of 20 patients), and recurrence rate (1 [5%] of 20 patients vs 1 [5%] of 20 patients). CONCLUSIONS: Stapled hemorrhoidectomy is associated with reduced postoperative pain, earlier recovery time and return to work, and a similar recurrence rate compared with the excision technique. Provided further clinical trials confirm these findings, stapled hemorrhoidectomy may become a future gold standard.
Adult↗
Comparison of different techniques of stapled bowel anastomoses in a canine model.
OBJECTIVE: To evaluate different methods of creating a stapled enteroanastomosis and to determine which method would create a larger anastomosis. DESIGN: Prospective comparison of three groups with a total of 17 mongrel dogs. SETTING: Clinical investigation facility. MAIN OUTCOME MEASURES: Stapled side-to-side enteroanastomoses were created with the stapled edges touching or separated. Anastomoses were created in both functional bowel and in a defunctionalized limb. The anastomotic circumference was measured in a blinded fashion after 28 days. The third group had anastomoses created and measured the same day. Groups were compared using the t test. RESULTS: There was significant narrowing after healing with both types of anastomoses. Anastomoses created by separating the stapled lines were larger than those fashioned with the cut edges touching, both immediately and after healing. CONCLUSIONS: While clinically significant narrowing of a stapled anastomosis is uncommon, separating the staple lines of a functional end-to-end anastomosis may be the preferable method.
Anastomosis, Surgical↗
Stapler hepatectomy is a safe dissection technique: analysis of 300 patients.
BACKGROUND: In many surgical procedures, stapling devices have been introduced for safety and to reduce the overall operative time. Their use for transection of hepatic parenchyma is not well established. Thus, the feasibility of stapler hepatectomy and a risk analysis of surgical morbidity based on intraoperative data have been prospectively assessed on a routine clinical basis. MATERIALS AND METHODS: From October 1, 2001, to January 31, 2005, a total of 416 patients underwent liver resection in our department. During this period endo GIA vascular staplers were used for parenchymal transection in 300 cases of primary (22%) and metastatic (57%) liver cancer, benign diseases (adenoma, focal nodular hyperplasia [FNH], cysts) (14%), gallbladder carcinoma (2%), and other tumors (5%). There were 193 (64%) major resections (i.e., removal of three segments or more) and 107 minor hepatic resections. Additional extrahepatic resections were performed in 44 (15%) patients. RESULTS: Median values for operative time and intraoperative hemorrhage were 210 minutes and 700 ml, respectively. Further, transfusion of RBC and FFP was needed in 17% and 11% of patients, respectively. A postoperative ICU stay for >2 days was required in 18% of patients. The median postoperative hospital stay was 10 days (IQR 8-14 days). The most frequent surgical complications were bile leak (8%), wound infection (3%), and pneumothorax (2%). In 7% of cases after stapler hepatectomy a relaparotomy was necessary. Treated medical complications were pleural effusion (7%), renal insufficiency (5%), and cardiac insufficiency (3%). Risk assessment revealed that both operative time and indication for resection had significant impact on surgical morbidity. Mortality (4%) and morbidity (33%) were comparable to other high-volume centers performing conventional liver resection techniques. CONCLUSION: In conclusion, stapler hepatectomy can be used in a routine clinical setting with a low incidence of surgical complications.
Aged↗
Management of renal allografts with multiple renal arteries resulting from laparoscopic living donor nephrectomy.
Laparoscopic living donor nephrectomy (LLDN) has become an accepted procedure in many transplant centers. The placement of laparoscopic vascular staples can result in multiple short, small-caliber renal arteries that the recipient surgeon must deal with to restore perfusion to all parts of the kidney. The incidence of multiple renal arteries resulting from LLDN, surgical management of multiple renal arteries, and the short- and long-term graft functions were studied in 73 consecutive kidney recipients at a single center. Various techniques used for reconstruction are described, including the use of recipient internal iliac artery for the extension and reconstruction of small-caliber, short renal vessels. Single-artery allografts were compared with those with multiple arteries, with length of renal artery, warm ischemia time, hospital length of stay, operating time, creatinine levels, and 1 yr survival rates not found to be significantly different. The presence of multiple renal arteries should not exclude the possibility of using the left kidney for LLDN.
Adult↗
Use of a non-penetrating staple device for spinal dural closure.
Closure of the spinal dura by suture can be technically demanding and a watertight closure is rarely achieved. A method of dural closure using non-penetrating staples is described which permits rapid watertight closure of the dura even in confined spaces.
Dura Mater↗
Laparoscopic oncologic total abdominal colectomy with intraperitoneal stapled anastomosis in a canine model.
The purpose of this study was to evaluate the feasibility of performing an oncologic type of colectomy using laparoscopic techniques with intraperitoneal stapled ileorectal anastomosis in a canine model. In 21 dogs, laparoscopic oncologic colectomy was carried out using dissection with a contact Nd:YAG laser. The right, middle colic, and inferior mesenteric arteries were transected close to their origins, and all adjacent mesenteric lymph nodes were removed. Ileorectal anastomosis was performed using a circular end-to-end stapler especially designed for laparoscopic surgery. Two weeks after surgery, all animals were killed. The number of remaining mesenteric lymph nodes, bursting pressure of ileorectal anastomosis, and postoperative morbidity were evaluated. No major intraoperative complications were recorded. One dog died postoperatively from an anastomotic leak. All dogs passed feces in the first 24 postoperative hours. Median operative time was 145 min (90-240 min). The number of remaining colonic mesenteric lymph nodes was 0, and median anastomotic bursting pressure was 325 mm Hg (183-415 mm Hg). The median distance from ileocolic anastomosis to anal verge was 8.5 cm (6.0-11.0 cm). Laparoscopic oncologic colectomy with wide mesenteric clearance of lymph nodes and intraperitoneal stapled ileorectal anastomosis is feasible and safe in a canine model.
Anastomosis, Surgical↗
Percutaneous transgastric technique for creating gastroenteric anastomoses in swine.
PURPOSE: To develop a percutaneous transgastric procedure for creating a stent-containing gastroenteric anastomosis (GEA). MATERIALS AND METHODS: Acute experiments were performed on eight pigs. A 10-F gastroduodenostomy sheath was used to insert guide wires and targeting devices in the retrogastric jejunal loop; a 6.5-F sheathed trocar needle was then introduced through a second gastric sheath to puncture and catheterize the jejunum through the back of the stomach. Two special sliding anchor pairs were introduced through the catheter to "sandwich" the gastric sheath to the jejunal wall. The jejunum was catheterized a third time between the anchor sets to create a GEA tract for insertion of a stent. The animals were killed at various periods as long as 1 month after the experiments. RESULTS: Snares were the most useful targeting devices for jejunal puncture. Single (n = 1) and double (n = 7) anchor-pair staples effectively prevented intraperitoneal leakage during and after insertion of 12-mm or 14-mm stents. Necropsy of six healthy animals at 5 days, 7 days, 14 days, and 4 weeks (n = 3) showed well-developed patent GEA anastomoses. There was one anesthetic death; one animal was killed at 4 days for obstructive ileus after a difficult transgastric jejunal catheterization. CONCLUSIONS: A GEA can be fashioned through a percutaneous gastrostomy with stapling anchors. This technique may have clinical applications for managing gastric outlet obstruction.
Anastomosis, Surgical↗
Nitinol compression staples for bone fixation in foot surgery.
We reviewed the use of compression staples made of the memory metal alloy nitinol for fixation in foot surgery. A retrospective study was performed of 31 feet in 27 patients who underwent arthrodesis or an osteotomy fixated using compression staples. OSStaples (BME, San Antonio, Texas) were used in 18 feet, and Memodyn staples (Telos Medical, Fallston, Maryland) were used in 13 feet. A total of 48 compression staples were implanted. The following procedures were performed and fixated using compression staples: 15 Akin osteotomies, 2 first metatarsal base epiphysiodeses, 3 first metatarsal-cuneiform fusions, 2 naviculocuneiform fusions, 3 calcaneocuboid fusions, 4 talonavicular fusions, 3 subtalar joint fusions, and 2 Evans osteotomies. In our clinical experience, compression staples provide an adequate source of internal fixation in foot surgery. Good bone apposition and stabilization and compression of the bone surfaces before staple fixation are important when using staple fixation to promote an optimal environment for bone healing.
Alloys↗
Technique to reduce air leaks after resection of emphysematous lung.
Wedge excision of emphysematous lung tissue by means of a stapling device is frequently associated with prolonged air leakage. We have used bovine pericardial strips to buttress the staple line, preventing air leakage, which otherwise can occur at the staple holes when the lung is reinflated.
Biological Dressings↗
Shoelace technique for delayed primary closure of fasciotomies.
Performing a timely fasciotomy for compartment syndrome prevents ischemic injury to muscles and nerves. Fasciotomy entails incision of the overlying skin and investing fascia of the compartment, relieving pressure and enhancing tissue perfusion. Delayed primary closure is ideal, but because of skin edge retraction, the open wound must either heal secondarily or be closed with a split-thickness skin graft. The shoelace technique involves running a silastic vessel loop through skin staples placed at the skin edge along the initial fasciotomy incision. Daily tightening of the shoelace permits gradual reapproximation of the skin edges while compartment edema resolves. Closure using a simple suture or Steri-strip (3M Surgical Products, St. Paul, Minnesota) is then possible after 5 to 10 days. The shoelace technique allows for gradual primary closure of open fasciotomy wounds, thereby avoiding the morbidity and cost associated with skin graft or secondary closure.
Compartment Syndromes↗
Laparoscopic aortic aneurysm resection.
PURPOSE: To describe a laparoscopic technique for resection of infrarenal abdominal aortic aneurysms (AAAs). METHODS: The operation is based on the principle of retroperitoneal reinforced staple exclusion of the aneurysm sac with aortobifemoral or aortoiliac bypass using gas and gasless laparoscopic techniques. Patients were eligible for this procedure if their infrarenal AAAs (with or without iliac artery involvement) were considered appropriate for surgical resection; however, renal or other visceral arterial stenoses, aneurysmal disease requiring surgical treatment, and/or aneurysms of the hypogastric arteries excluded patients from laparoscopic AAA resection. RESULTS: Of 31 candidates for this procedure, 9 were excluded owing to high surgical risk. Twenty-two patients (16 males; age range 62 to 88 years) were deemed appropriate for the laparoscopic procedure. Maximum aneurysm diameter ranged from 4.0 to 8.0 cm. The operation was completed successfully in 20 (91%) patients. Two (9%) deaths in high-risk patients admitted early to the study occurred within 30 days of surgery. The only major complication was an injured ureter, for which a nephrectomy was performed. Comparison to a historical cohort of conventionally treated patients showed that the study group needed less ventilator support, had shorter intensive care and hospital stays, and resumed diet earlier despite relatively prolonged anesthesia and aortic clamping times. CONCLUSIONS: The laparoscopic approach to infrarenal AAAs appears feasible, with several potential advantages in low- and moderate-risk patients. Once the technique is optimized, randomized prospective studies will be needed to verify the apparent benefits demonstrated by these initial patients.
Aged↗
Gastroesophagostomy after proximal gastrectomy using a double stapling technique.
Explore the source record for details and available documents.
Esophagostomy↗
Further cautionary tales from histopathology of stapled haemorrhoidopexy specimens.
Explore the source record for details and available documents.
Aged↗
Triple-stapled low colorectal anastomosis for the narrow pelvis.
Standard linear staplers for transverse occlusion of the rectum is sometimes too large to be applied in a narrow pelvis. A proximate TL 30 (Ethicon, Inc., Somerville, NJ) is easily introduced and applied twice for occlusion of the rectum, followed by anastomosis with a circular stapler. This triple-stapling technique is a safe and easy procedure for low colorectal anastomosis in a narrow pelvis.
Anastomosis, Surgical↗
Small bowel obstruction secondary to stapled laparoscopically assisted vaginal hysterectomy.
BACKGROUND: This study analyzes the complication of small bowel obstruction following stapled division of the adnexa during laparoscopically assisted vaginal hysterectomy (LAVH). METHODS: We reviewed the records of three patients with small bowel obstruction following stapled LAVH. We then tested the proposed mechanisms of obstruction by firing endoscopic staplers across silicon tubing to simulate division of the adnexal structures. Staple shape, spillage, and closure were analyzed. RESULTS: Small bowel obstruction can result when a partially formed endoscopic staple hooks the small bowel. The problem can be traced to either spilled intraperitoneal staples or partially formed staples that adhere to part of the adnexal staple line. The mechanisms staple closure, spillage, and ability to hook small bowel were confirmed with a laboratory model. CONCLUSIONS: Techniques for reducing the incidence of small bowel obstruction following stapled LAVH include minimizing staple spillage and careful inspection of the adnexal staple line for partially formed staples.
Adult↗
Perioperative topical nitrate and sphincter function in patients undergoing transanal stapled anastomosis: a randomized, placebo-controlled, double-blinded trial.
PURPOSE: The use of transanal stapling devices may impair continence because of digital dilatation and/or instrumentation. This study assessed the effect of pharmacological dilatation of the sphincter prior to stapler insertion. METHODS: A randomized, placebo-controlled, double-blinded study of 60 patients undergoing transanal stapled anastomosis was undertaken. Consenting patients were randomly assigned to receive a single intraoperative dose of topical 0.2 percent nitroglycerin (glyceryl trinitrate) ointment or nitroglycerin-free placebo. All patients were assessed preoperatively and postoperatively by clinical methods (Wexner incontinence scores and examination), anorectal manometry by a station pull-through technique, and endoanal ultrasonography. RESULTS: Intraoperative mean (+/-SEM) resting pressures (mmHg) were significantly reduced by nitroglycerin compared with prenitroglycerin levels (9.9 +/- 0.9 vs. 50.5 +/- 2.7; P = 0.002) or controls (56.0 +/- 3.2; P = 0.001). Twenty-one of the 28 controls (75 percent) but only 4 of the 32 patients in the nitroglycerin group (12.5 percent) required digital dilatation to insert the stapling instrument ( P = 0.003). Squeeze pressures were unaltered by the intervention but mean resting pressures were higher in the nitroglycerin group postoperatively (52.9 +/- 3.2 - 31.6 +/- 1.3 = 21.3 mmHg; 95 percent confidence interval, 14-27). Incontinence scores were lower in the nitroglycerin group at the 3-month (1.1 +/- 0.2 vs. 4.6 +/- 0.3; P = 0.003) and 12-month (0.9 +/- 0.1 vs. 4.4 +/- 0.3; P = 0.002) clinic visits. CONCLUSION: Preoperative nitroglycerin dilatation protects sphincter function in patients undergoing transanal stapled anastomoses.
Administration, Topical↗
Elimination of mucosectomy during restorative proctocolectomy in patients with ulcerative colitis may provide better results in low-volume centers.
BACKGROUND: To compare the outcomes of hand-sewn and double-stapling techniques among ulcerative colitis patients undergoing restorative proctocolectomy at a center that has limited experience with restorative proctocolectomy. METHODS: Forty-four patients with ulcerative colitis were divided into two groups according to the anastomosis techniques: hand sewing and double stapling. Postoperative early and late complications, postoperative hospital stay, and long-term functional results were compared. RESULTS: Pelvic sepsis (9% versus 36%, P = 0.03), operation time (median 240 minutes versus 270 minutes, P = 0.01), postoperative hospital stay (median 9 days versus 12 days, P = 0.04), and night incontinence (42% versus 80%, P = 0.07) were less common in the double-stapling group. CONCLUSIONS: We recommend the double-stapling technique to centers that do not have extensive experience with restorative proctocolectomy for ulcerative colitis. This technique provides a good postoperative course in most patients and provides satisfactory long-term results. The results of the double-stapling group were similar to the results of the high-volume centers.
Adolescent↗