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At least 487 records · Page 27Linked to original sources
PubMed1997

Gelatin-resorcinol-formaldehyde-glutaraldehyde glue-spread stapler prevents air leakage from the lung.

BACKGROUND: To reinforce the staple line of the emphysematous lung and thereby prevent air leakage during thoracoscopic operations, we have developed a procedure of lung excision that uses a gelatin-resorcinol-formaldehyde-glutaraldehyde (GRFG) glue-spread stapler. METHODS: Formaldehyde-glutaraldehyde (FG) jelly is prepared by mixing FG fluid with 2.5% sodium carboxymethyl cellulose. The FG jelly is placed in the stapler groove and staple holes, and a gelatin-resorcinol (GR) mixture is applied. The GRFG glue-spread stapler was applied to emphysematous lung cutting during thoracoscopic operations in 10 cases. RESULTS: An adhesion-strength test showed no difference in glue adhesion between FG fluid and FG jelly. An experiment using swine lung showed that with this newly developed stapler, no resistance in firing occurred, and GRFG glue covered every staple hole. Clinical application in 10 cases with emphysematous lung demonstrated no air leakage from the staple line, even long after the operation. CONCLUSIONS: Emphysematous lung excision using the GRFG glue-spread stapler during thoracoscopic operations is useful in preventing air leakage from the staple line and is a simple, safe, and low-cost procedure.

Drug Combinations↗
PubMed1998

Bovine pericardium versus bovine collagen to buttress staples for lung reduction operations.

BACKGROUND: Air leaks after stapled lung volume reduction operations for emphysema remain the most common postoperative complication. Cooper developed the use of bovine pericardium buttress for the staple lines in an attempt to decrease the occurrence of prolonged postoperative air leaks. However, the materials cost for a bilateral procedure may add $3,000 to $4,000 to the cost of the operation. We undertook this study to evaluate the efficacy of a less expensive buttress. METHODS: Fifty-seven patients underwent a bilateral thoracoscopic stapled operation with bovine pericardium (Peri-Strips) on one side and bovine collagen (INSTAT) on the contralateral side to buttress the staples. RESULTS: The average time to chest tube removal was 8.6 +/- 7.2 days for Peri-Strips and 10.7 +/- 8.7 days for INSTAT (p = 0.16). No significant differences were seen when right-sided and left-sided application were considered separately (p = 0.12). CONCLUSIONS: Peri-Strips or INSTAT for buttressing staple lines in thoracoscopic stapled bilateral lung volume reduction operations were equally effective. Materials cost savings of up to 80% per case can be realized by using the less expensive but equally effective INSTAT for buttressing staple lines.

Aged↗
PubMedDate not supplied

Hemiepiphyseal stapling for knee deformities in children younger than 10 years: a preliminary report.

Epiphyseal stapling, which is the only reversible method of growth alteration, has traditionally been reserved for teenagers. We are reporting the application of hemiepiphyseal stapling in a series of 25 children younger than 10 years. With a variety of underlying diagnoses, three children had genu varum and 22 had genu valgum. The technique involved fluoroscopic localization of all growth plates and careful preservation of the periosteum while inserting (and subsequently removing) one or two staples per physis. The mean age at stapling was 6 years + 4 months. Follow-up averaged 3 years + 3 months. The anatomic (tibiofemoral) angle and mechanical axis improved in all patients. One staple broke on removal; there were no other hardware failures. We conclude that hemiepiphyseal stapling is a safe and effective treatment for children younger than 10 years who have angular deformities of the knee. No growth-plate arrests have occurred. In the event of recurrent deformity, stapling may be repeated.

Bone Diseases, Developmental↗
PubMed2000

Long-term results of stapled and hand-sewn anastomoses in patients with Crohn's disease.

AIM: This study aimed at determining the reoperation rates of patients with anastomoses for Crohn's disease. The outcome of patients undergoing stapled anastomoses was compared with that of patients having hand-sewn anastomoses. METHODS: Sixty-three patients undergoing intestinal resection for Crohn's disease at our institution from 1987 to 1996 were studied in a prospective, randomized trial. The group undergoing stapling comprised 30 patients and 37 anastomoses. The group with a hand-sewn anastomosis comprised 33 patients and 45 anastomoses. The median follow-up period was 87 (range 36-140) months. RESULTS: There were no significant differences in operative indications or patients' age and sex between the groups. There was a significant difference in cumulative recurrences between the groups (Cox-Mantel test: p = 0.022). CONCLUSION: A stapled anastomosis after resection for Crohn's disease may delay reoperation in patients with symptomatic recurrence.

Adolescent↗
PubMed2002

Stapled versus handsewn methods for colorectal anastomosis surgery: a systematic review of randomized controlled trials.

CONTEXT: The interest in the results from comparisons between handsewing and stapling in colorectal anastomoses has been reflected in the progressive increase in the number of clinical trials. These studies, however, do not permit conclusions to be drawn, given the lack of statistical power of the samples analyzed. OBJECTIVE: To compare stapling and handsewing in colorectal anastomosis, testing the hypothesis that in colorectal anastomosis the technique of stapling is superior to that of handsewing. DESIGN: A systematic review of randomized controlled trials. SURVEY STRATEGY: Systematic revision of the literature and meta-analysis were used, without restrictions on language, dates or other considerations. The sources of information used were Embase, Lilacs, Medline, Cochrane Controlled Clinical Trials Database, and letters to authors and industrial producers of staples and thread. SELECTION CRITERIA: Studies were included in accordance with randomization criteria. The external validity of the studies was investigated via the characteristics of the participants, the interventions and the variables analyzed. An independent selection of clinical studies focusing on analysis of adult patients attended to on an elective basis was made by two reviewers. DATA COLLECTION AND ANALYSIS: The methodological quality of the studies was assessed by the same reviewers. In addition to the randomization criteria, the masking, treatment intention, losses and exclusions were also analyzed. The meta-analysis was performed using risk difference and weighted average difference, with their respective 95% confidence intervals. The variables studied were mortality, clinical and radiological anastomotic dehiscence, anastomotic stricture, hemorrhage, reoperation, wound infection, time taken to perform the anastomosis and hospital stay. RESULTS: Nine clinical trials were selected. After verifying that it was possible to perform one of the two techniques being compared, 1,233 patients were included, of whom 622 underwent stapling and 611 the handsewing technique. No statistical difference was found between the variables, except for stenosis, which was more frequent in stapling (p < 0.05), and the time taken to perform the anastomosis, which was greater in handsewing (p < 0.05). CONCLUSION: The evidence found was insufficient to demonstrate superiority of the stapling method over handsewing, independent of the level of colorectal anastomosis.

Anastomosis, Surgical↗
PubMed1994

Utility of the biofragmentable anastomotic ring in traumatic small bowel injury.

OBJECTIVE: To evaluate the use of the 25 mm Biofragmentable Anastomotic Ring (BAR) in traumatic small bowel injury. METHODS: In a one year prospective, nonrandomized study, 18 patients (x age = 25 yrs) with penetrating small bowel injury had 25 BAR devices placed to restore intestinal continuity. Using one-way analysis of variance, this group was compared to 63 historical controls (x age = 27 yrs) with small bowel trauma who had either sutured or stapled anastomoses (SSA), with regard to Penetrating Abdominal Trauma Index (PATI) score, time until return of bowel function, and postoperative morbidity. RESULTS: PATI scores for the two groups were not significantly different (P = 0.099). No deaths in the SSA group (n = 8) or in the BAR group (n = 1) were related to the anastomotic technique. There was no significant difference (P = 0.991) in the rate of post-operative intestinal obstruction between BAR (n = 3) and SSA (n = 8) groups; none of the BAR patients required re-operation. The average length of time for return of bowel function was not significantly different (P = 0.197) between BAR (4.3 days) and SSA (5.8 days) groups. CONCLUSIONS: The 25 mm BAR may be used in the repair of traumatic small bowel injury, based upon comparable outcomes when compared with sutured and stapled anastomoses.

Adolescent↗
PubMed2001

Stapled versus handsewn methods for colorectal anastomosis surgery.

BACKGROUND: Randomized controlled trials comparing stapled with handsewn colorectal anastomosis have not shown either technique to be superior, perhaps because individual studies lacked statistical power. A systematic review, with pooled analysis of results, might provide a more definitive answer. OBJECTIVES: To compare the safety and effectiveness of stapled and handsewn colorectal anastomosis. The following primary hypothesis was tested: the stapled technique is more effective because it decreases the level of complications. SEARCH STRATEGY: The RCT register of the Cochrane Review Group was searched for any trial or reference to a relevant trial (published, in-press, or in progress). All publications were sought through computerised searches of EMBASE, LILACS, MEDLINE, the Cochrane Controlled Clinical Trials Database, and through letters to industrial companies and authors. There were no limits upon language, date, or other criteria. SELECTION CRITERIA STUDIES: All randomized clinical trials (RCTs) in which stapled and handsewn colorectal anastomosis were compared. PARTICIPANTS: Adult patients submitted electively to colorectal anastomosis. INTERVENTIONS: Endoluminal circular stapler and handsewn colorectal anastomosis. OUTCOMES: a) Mortality b) Overall Anastomotic Dehiscence c) Clinical Anastomotic Dehiscence d) Radiological Anastomotic Dehiscence e) Stricture f) Anastomotic Haemorrhage g) Reoperation h) Wound Infection i) Anastomosis Duration j) Hospital Stay. DATA COLLECTION AND ANALYSIS: Data were independently extracted by the two reviewers (SASL, DM) and cross-checked. The methodological quality of each trial was assessed by the same two reviewers. Details of the randomization (generation and concealment), blinding, whether an intention-to-treat analysis was done, and the number of patients lost to follow-up were recorded. The results of each RCT were summarised on an intention-to-treat basis in 2 x 2 tables for each outcome. External validity was defined by characteristics of the participants, the interventions and the outcomes. The RCTs were stratified according to the level of colorectal anastomosis. The Risk Difference method (random effects model) and NNT for dichotomous outcomes measures and weighted mean difference for continuous outcomes measures, with the corresponding 95% confidence interval, were presented in this review. Statistical heterogeneity was evaluated by using funnel plot and chi-square testing. MAIN RESULTS: Of the 1233 patients enrolled ( in 9 trials), 622 were treated with stapled, and 611 with manual, suture. The following main results were obtained: a) Mortality: result based on 901 patients; Risk Difference - 0.6% Confidence Interval -2.8% to +1.6%. b) Overall Dehiscence: result based on 1233 patients; Risk Difference 0.2%, 95% Confidence Interval -5.0% to +5.3%. c) Clinical Anastomotic Dehiscence : result based on 1233 patients; Risk Difference -1.4%, 95% Confidence Interval -5.2 to +2.3%. d) Radiological Anastomotic Dehiscence : result based on 825 patients; Risk Difference 1.2%, 95% Confidence Interval -4.8% to +7.3%. e) Stricture: result based on 1042 patients; Risk Difference 4.6%, 95% Confidence Interval 1.2% to 8.1%. Number needed to treat 17, 95% confidence interval 12 to 31. f) Anastomotic Hemorrhage: result based on 662 patients; Risk Difference 2.7%, 95% Confidence Interval - 0.1% to +5.5%. g) Reoperation: result based on 544 patients; Risk Difference 3.9%, 95% Confidence Interval 0.3% to 7.4%. h) Wound Infection: result based on 567 patients; Risk Difference 1.0%, 95% Confidence Interval -2.2% to +4.3%. i) Anastomosis duration: result based on one study (159 patients); Weighted Mean Difference -7.6 minutes, 95% Confidence Interval -12.9 to -2.2 minutes. j) Hospital Stay: result based on one study (159 patients), Weighted Mean Difference 2.0 days, 95% Confidence Interval -3.27 to +7.2 days. REVIEWER'S CONCLUSIONS: The evidence found was insufficient to demonstrate any superiority of stapled over handsewn techniques in colorectal anastomosis, regardless of the level of anastomosis.

Adult↗
PubMed2001

Patency and flow characteristics using stapled vascular anastomoses in dialysis grafts.

BACKGROUND: Improving patency of hemodialysis grafts is challenging. Vascular stapling creates nonpenetrating anastomoses, possibly decreasing intimal hyperplasia. We investigated patency and flow characteristics of stapled hemodialysis grafts. METHODS: Eighty-six grafts (41 stapled, 45 sewn) were placed in 84 patients (prospective, randomized). The groups had comparable demographics. RESULTS: Thirty-six grafts were functioning at the study endpoint. Complications in both groups were similar. The primary patency (stapled, 342 days versus sewn, 382 days; P = 0.67) and secondary patency (stapled, 513 days versus sewn, 507 days; P = 0.76) had no significant differences. Flow characteristics were similar between the groups. Thrombectomies per patient-year were 1.01 for stapled grafts and 1.12 for sewn grafts (not significant). Stapling decreased the average operating time by 4.5 minutes. CONCLUSIONS: Stapled and sewn anastomoses have similar primary and secondary patency and flow characteristics, with minimal operative time differences. Stapled anastomoses are safe but had no advantage over sewn anastomoses in this study.

Anastomosis, Surgical↗
PubMed2006

How we do it: improving the success of endoscopic pharyngeal pouch stapling.

A simple technique to improve the success rate of endoscopic stapling diverticulotomy of pharyngeal pouches is described. Equipment used is readily available. This technique can be used in difficult cases when the pouch cannot be visualised using a Weerda diverticuloscope. It reduces the need for conversion to an open surgical procedure with associated increased risk of complications.

Aged↗
PubMed1997

[Osteosynthesis of internal malleolar fracture by staplers].

PURPOSE OF THE STUDY: Rigid medial and lateral fixation should stabilize the syndesmosis without further additional supplementation. We used Titanium staples for medial malleolar fixation. MATERIAL: This study included 21 medial malleolar fractures (6 isolated medial malleolar fractures). Ankle fractures were classified according to Weber's system for lateral malleolar fracture. TECHNICAL: Tension band was used for Weber A lateral malleolar fracture and a plate for Weber B and C. One Weber A fracture was stabilized by staples. After reduction with clamps, three staples are placed perpendicular to the fracture line. All medial malleolar fractures were treated by staples including comminutive fractures or fractures who extended proximally into the tibia pilon. Only three transversal fractures of the anterior rim were treated by staples. Closure was made without any drainage. A below the knee cast was placed for 6 weeks. RESULTS: All fractures healed without further displacement. According to Weber Score, eleven ankle had an excellent result, seven a good result and three a bad result. We never removed the staples except in one case of technical error. DISCUSSION: Titanium staple present an attractive alternative for medial malleolar fixation. Plaster cast don't impair ankle function. Titanium staples are easy to use, are of little bulk and removal is not necessary. Skie et al. described three types of anterior rim fracture: one transversal and two oblique. The small size of the fragment makes reduction difficult to maintain, and impacted staple tends to displace laterally this small fragment. In this series we stapled only transverse fracture of the anterior rim (three times). But even in this case, it is difficult to maintain reduction during stapling. In case of lass of reduction, removal of the staple is responsible for fragmentation of the small fragment. Excluding the anterior rim fracture, other fractures, including T fractures and fractures who extend to the tibial pilon can be treated by this technique. CONCLUSION: Titanium staple is easy to use in medial malleolar fractures excluding anterior rim fractures.

Adult↗
PubMedDate not supplied

[Total gastrectomy with mechanical sutures].

Between 1994-1996, nine consecutive patients underwent total gastrectomy with stapled sutures for II, III or IV TNM stage carcinoma (8 patients) or lymphoma (1 patient) of the middle or upper stomach. Digestive continuity was established by stapled end-to-side "ended", end-to-side and end-to-end Roux-en-Y (7 patients) and omega loop (2 patients) esophagojejunal anastomoses using circular staplers (EEA or ILS). The duodenal stump and the end of the Roux loop were closed with TA 55 or TA 30 linear stapler. Interjejunal anastomoses were hand sewn. Nasojejunal feeding catheter was placed for ten days in all patients. No postoperative mortality non anastomotic fistula occurred. One patient had duodenal stump leakage which closed spontaneously. In three patients postoperative chemotherapy with 5-FU and Leucovorian was associated. At late follow-up, there were two patients with reflux esophagitis cured by medical treatment and one patient with peritoneal and hepatic metastases at relaparotomy. In conclusion, the use of stapled sutures in total gastrectomy facilitates esophagojejunal anastomosis and improves suture reliability.

Adenocarcinoma↗
PubMed1986

Healing of esophagojejunal anastomoses after experimental total gastrectomy. A comparative study using manually sutured or stapled anastomoses.

In construction of the eosphagojejunostomy after total gastrectomy, the EEA stapled (US Surgical Corporation, Norwalk, CT) and the two-layer interrupted 3-0 Dexon anastomoses are compared concerning the radiological appearance, breaking strength, circulation, and collagen concentration. Thirty female pigs were used. After total gastrectomy and Roux-en-Y preparation, the pigs were randomized to achieve sutured or stapled anastomoses. 141Ce-labeled microspheres were used for measurements of anastomotic blood flow. After the pigs were killed, the breaking strength of the anastomosis was recorded, the collagen content determined, and an anastomotic index calculated comparing two perpendicular diameters in the anastomosis and 5 cm above. Breaking strength, leakage frequency, and anastomotic index were the same in the two groups. One week after surgery, there was a significant increase in anastomotic circulation (p less than 0.05) in both the sutured and the stapled anastomoses compared to controls. Collagen increased equally with time in the two groups (p less than 0.01). The stapled esophagojejunostomy was faster to perform (20 min) than the sutured (28 min) (p less than 0.05).

Animals↗
PubMed1994

The influence of the number of endoclips and of mesh incorporation on the strength of an experimental hernia patch repair.

The strength conferred to a mesh by fixing it with laparoscopic staples and the effects of tissue incorporation have never been quantified. Eighteen dogs were divided into three groups sacrificed at 2 days (5 dogs), 2 weeks (6 dogs), and 2 months (7 dogs). One 3.5- by 5-cm piece of abdominal wall was removed from each side through a median laparotomy, leaving the skin intact. A polypropylene mesh (5 by 7 cm) was fixed over one defect with four Endopath EMS staples (Ethicon Endo-surgery) and over the other with 16 EMS staples. At sacrifice, bursting strength (BS) was measured with an Instron tester and specimens were studied histologically. One-way analysis of variance and the Newmann-Keuls multiple-comparison test were used. BS tests showed that for each period studied, the strength of the repair performed with 16 staples was significantly higher than that obtained when four staples were applied. They also showed that tensile strength increased significantly in both groups as time elapsed. Light microscopy supported the conclusion that the initial strength of the repair was related to the number of clips and was significantly increased by cellular infiltration at 2 weeks and significantly more by collagen deposition at 2 months. At 2 months, BS was significantly higher in the 16-staples group, suggesting that initial fixation still plays a significant role.

Abdominal Muscles↗
PubMed1999

Pharyngeal pouch endoscopic stapling--are post-operative barium swallow radiographs of any value?

Posterior pharyngeal pouch endoscopic stapling has gained increasing popularity among otolaryngologists especially in elderly patients. Post-operative barium swallow appearances can create confusion with the appearance of persistent pouches. We describe our experience in 10 patients, three of whom had external excision with cricopharyngeal myotomy and the remaining seven had endoscopic stapling approach. All three patients who had external excision showed no residual pouch whereas all seven patients who had endoscopic techniques performed showed some residual pouch. We were unsuccessful in our attempt to correlate post-operative symptoms with radiological appearance. Attempts by other radiologists at identifying pre- and post-operative barium swallow radiographs in patients who had endoscopic stapling of pharyngeal pouch were unsuccessful. We conclude that post-operative barium swallow radiography plays no role in determining the success of endoscopic stapling of pharyngeal pouch.

Aged↗