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At least 127 records · Page 7Linked to original sources

PubMed1996

Fetal surgical protocols in Yucatan miniature swine.

Thirty-nine Yucatan miniature swine were used in three fetal surgical experimental protocols. They involved antiarrhythmic administration, pacemaker implantation, and in-utero diagnosis of ventricular septal defect by intraoperative echocardiography. Because of problems encountered with surgical protocols in the initial stages, modifications were made to prevent fetal hypothermia and intraoperative mortality. These modifications included environmental temperature support, staple surgical techniques to reduce operative time, and development of fetal catheters designed to facilitate cannulation of small vessels. Postoperative care protocols were intensive and included antibiotics, analgesics, and supportive care designed to reduce discomfort and prevent abortion and sepsis. Thirty-seven of 39 sows survived the surgical procedures; experiments were performed on 117 fetuses. Twenty-two fetuses died either intraoperatively or postoperatively because of complications related to the experimental protocols. Modification of surgical and postsurgical protocols for these projects demonstrates the feasibility of using miniature swine as a model for fetal surgery, when their use was appropriate for anatomic and physiologic reasons.

Animals↗

PubMed2003

Pulmonary granuloma possibly caused by staples after video-assisted thoracoscopic surgery.

A 74-year-old man, with a history of colon cancer resection and video-assisted thoracoscopic surgery (VATS) resection of pulmonary metastases, was found to have a left pulmonary nodule near the previous staple-line. The size of this nodule increased during follow-up. Because of this clinical course, this nodule was considered to be a tumor recurrence at the staple-line, and pulmonary re-resection was performed. The pathologic diagnosis of this nodule was foreign body granuloma (FBG) possibly due to previous surgical staples. FBG induced by staples may be a rare complication in VATS.

Aged↗

PubMed2005

Transanal repair of rectocele and full rectal mucosectomy with one circular stapler: a novel surgical technique.

We present a new surgical stapling technique for treatment of rectocele when associated with internal mucosal prolapse or haemorrhoids using only one circular mechanical stapler. Eight female patients, mean age 53 years (range, 42-70), complaining of obstructed defecation with vaginal digitation because of rectocele associated with internal mucosal prolapse underwent transanal repair of rectocele and rectal mucosectomy using one circular stapler between April and July 2004. A running horizontal mattress suture was placed through the base of the rectocele including mucosa, submucosa and the muscle layer of the whole anterior anorectal junction wall. The prolapsed mucosa and the muscular layer were then excised with an electrical scapel. A continuous pursestring rectal mucosa suture was placed 0.5 cm before the previous anterior mucosa and muscle layers resected wound, including the anorectal junction wall which was kept separate from the posterior vaginal wall by a Babcock forceps. Posteriorly, the pursestring suture included only mucosal and submucosal layers. The stapled suture was positioned between normal anterior rectal wall and the anal canal, 0.5 cm above the pectinate line. The stapler was then closed, fired and withdrawn. One patient complained of a perianal hematoma on the seventh postoperative day, requiring surgical excision. Postoperative defecography showed correction of the rectocele and outlet obstruction disappeared in all patients. This novel combined manual-stapled technique for rectocele and rectal internal mucosal prolapse seems to be a safe procedure and the preliminary results are encouraging. Further investigations have to be performed to assess long-term outcome in a larger number of patients.

Adult↗

PubMed1991

[Current status and perspectives of mechanical suture techniques in abdominal and thoracic surgery].

In surgery the application of mechanical suture techniques is increasing. In order to inform the surgeons in detail about the different surgical stapling instruments being available today, the mechanical suture devices are listed in this article. These instruments can be divided into linear staplers, circular and linear anastomosis staplers, ligating clips and skin and fascia staplers. Own experiences with stapling instruments, their advantages and disadvantages as well as the different forms of application are described. Further information is given on the increasing use of absorbable staples and of new anastomosis techniques, i.e. instruments creating an anastomosis on the principle of compression.

Abdomen↗

PubMed1992

Improved surgical approach to left atrial appendage aneurysm.

Left atrial appendage aneurysm is a rare anomaly, which usually presents with arrhythmia or cerebral embolism. Diagnostic evaluation traditionally required cardiac catheterization, and surgical resection required cardiopulmonary bypass. Utilizing intraoperative transesophageal echocardiography and surgical stapling devices, we have streamlined our operative technique, allowing resection of a left atrial appendage aneurysm without cardiopulmonary bypass. This report of two cases treated over the past decade demonstrates the evolution of our surgical technique.

Adult↗

PubMed1988

Acute colonic diverticulitis.

Colonic diverticulosis is truly a disease of the 20th century. A direct correlation is thought to exist between the incidence of diverticular disease and the amount of dietary fiber. Acute colonic diverticulitis occurs in approximately 25 per cent of the patients with diverticula, and 20 per cent of the patients with diverticulitis will ultimately require surgical intervention. Because of the often virulent nature of the disease in younger patients and the prevalence in the geriatric population, an aggressive approach is advocated. Primary resection of the involved segment of colon is advocated in all cases requiring operation. A primary anastomosis can be constructed in stage I and some cases of stage II disease. This results in lower morbidity and mortality rates as well as fewer days of hospitalization and disability. Newer techniques such as diagnostic CT scanning, percutaneous drainage of diverticular abscess, and greater application of surgical stapling devices have done much to improve the ultimate outcome of colonic diverticulitis.

Abdomen, Acute↗

PubMed2001

Stapled versus sutured gastrointestinal anastomoses in the trauma patient: a multicenter trial.

BACKGROUND: Construction of gastrointestinal anastomoses utilizing stapling devices has become a familiar procedure. In elective surgery, studies have shown no significant differences in complications between stapled and sutured anastomoses. Controversy has recently arisen regarding the accurate incidence of complications associated with anastomoses in the trauma patient. The objective of this multi-institutional study was to determine whether the incidence of postoperative complications differs between stapled and sutured anastomoses following the emergent repair of traumatic bowel injuries. METHODS: Using a retrospective cohort design, all trauma registry records from five Level I trauma centers over a period of 4 years were reviewed. RESULTS: A total of 199 patients with 289 anastomoses were identified. A surgical stapling device was used to create 175 separate anastomoses, while a hand-sutured method was employed in 114 anastomoses. A complication was defined as an anastomotic leak verified at reoperation, an intra-abdominal abscess, or an enterocutaneous fistula. The mean abdominal Abbreviated Injury Scale score and Injury Severity Score were similar in the two cohort groups. Stapling and suturing techniques were evenly distributed in both small and large bowel repairs. Seven of the total 175 stapled anastomoses and none of the 114 hand-sewn anastomoses resulted in a clinically significant leak requiring reoperation (RR = undefined, 95% CI 1.08-infinity, p = 0.04). Each anastomotic leak occurred in a separate individual. Nineteen stapled anastomoses and four sutured anastomoses were associated with an intra-abdominal abscess (RR = 2.7, 95% CI 0.96-7.57, p = 0.04). Enterocutaneous fistula formation was not statistically associated with either type of anastomoses (stapled cohort = 3 of 175 and sutured cohort = 2 of 114). Overall, 22 (13%) stapled anastomoses and 6 (5%) sutured anastomoses were associated with an intra-abdominal complication (RR = 2.08, 95% CI 0.89-4.86, p = 0.076). CONCLUSION: Anastomotic leaks and intra-abdominal abscesses appear to be more likely with stapled bowel repairs compared with sutured anastomoses in the injured patient. Caution should be exercised in deciding to staple a bowel anastomosis in the trauma patient.

Adolescent↗

PubMed1999

Stapled versus sutured gastrointestinal anastomoses in the trauma patient.

BACKGROUND: Construction of gastrointestinal anastomoses by using stapling devices has become a familiar procedure. Most studies have shown no significant differences in complication rates between stapled and sutured anastomoses performed during elective surgery. To date, no study has evaluated the incidence of complications of stapled anastomoses in the trauma patient. The purpose of our study was to determine whether the incidence of postoperative complications differs between stapled and sutured anastomoses after the emergent repair of traumatic bowel injuries. METHODS: A retrospective analysis of the medical and institutional trauma registry records of patients identified to have undergone a gastrointestinal anastomosis in a regional Level I trauma center over a 4-year period. RESULTS: A total of 84 patients with 118 gastrointestinal anastomoses were identified. A surgical stapling device was used to create 58 separate anastomoses, whereas a hand-sutured method was used in 60 anastomoses. A complication was defined as an anastomotic leak verified at reoperation. The ratio of blunt versus penetrating injuries, mean abdominal Abbreviated Injury Scale score, and Injury Severity Score were similar in the two groups. Stapling and suturing techniques were evenly distributed between small and large bowel repairs. Mean intensive care unit length of stay was comparable in both cohorts. However, inpatient length of stay was longer in patients with solely a stapled anastomosis compared with sutured anastomoses. Four of the 58 stapled anastomoses and none of the 60 hand-sewn anastomoses resulted in a clinically significant leak requiring reoperation (relative risk = undefined; 95% confidence interval, 1.14-infinity; p = 0.037). Each anastomotic leak occurred in a separate individual. The only death occurred in the stapled cohort secondary to peritonitis and subsequent sepsis. CONCLUSION: Anastomotic leaks seem to be associated with stapled bowel repairs compared with sutured anastomoses in the traumatically injured patient.

Adult↗

PubMed2005

Operative therapy for cecal volvulus combining resection with colopexy.

BACKGROUND: Cecal volvulus is an uncommon clinical event. The literature contains many recommended treatments with varied results. STUDY DESIGN: A series of 10 consecutive patients treated by the author was reviewed. Each patient had complete clinical follow-up. The cecal volvulus was resected without detorsion and reperfusion of the volvulus. The intestine was resected using a surgical stapling device, transection of the mesentery at the axial twist, and a stapled anastomosis of the terminal ileum to the remnant of the right colon. Permanent sutures between the colonic tenia and the peritoneum of the right paracolic gutter fixed the remainder of the right colon to prevent recurrence of the volvulus. RESULTS: The author in clinical practice surgically treated a series of 10 consecutive patients with complete follow-up between 1981 to 2004. All patients survived the surgical procedure and were discharged from the hospital. The diagnosis was determined preoperatively in 5 of the 10 patients. Five patients had gangrene of the colon, and two of these patients had perforation. All patients required postoperative intensive care from 2 to 9 days. Five of the 10 patients required ventilator support for 1 to 3 days. Postoperative complications included intraperitoneal bleeding, pneumonia, and surgical incision infection with a subcutaneous abscess. There has been no recurrence of the volvulus in any of these patients. CONCLUSIONS: Ten consecutive cases of cecal volvulus were surgically treated by a uniform resection procedure. The cecal volvulus was not reperfused by detorsion. Reperfusion of ischemic or gangrenous bowel can possibly produce reperfusion injury, metabolic acidosis, intestinal bacterial, and toxin translocation with possible irreversible septic shock. Recurrence of the cecal volvulus was prevented by colopexy of the right colon remnant. Avoidance of reperfusion of the cecal volvulus with resection, primary anastomosis, and colopexy resulted in successful results in a small series in clinical practice.

Adult↗

PubMed1992

Lithiasis in the ileal conduit and the continent urinary pouch: two cases and a review.

We present 2 patients who developed stones (6 and 57 g) in the ileal conduit; the first stone was passed and the second required surgical removal; its nidus was a surgical staple. After a review of the literature which includes 25 other cases of stones in ileal conduits, as well as over 20 cases of stones in continent urinary pouches, it is concluded that the use of metallic staples in the construction of the ileal conduit or the continent urinary pouch should be abandoned.

Foreign-Body Reaction↗

PubMed2003

Reducing time to oral diet and hospital discharge in patients undergoing radical cystectomy using a perioperative care plan.

OBJECTIVES: To outline our current perioperative treatment of patients undergoing radical cystectomy and urinary diversion, which uses advancements in perioperative care to allow for early institution of an oral diet and early hospital discharge, and thereby overall improvement in patient recovery and outcome after this procedure. METHODS: Forty consecutive patients underwent radical cystectomy and urinary diversion with curative intent from 2001 to 2002. A care plan was followed for all patients and included improvements in preoperative, intraoperative, and postoperative care. The preoperative care included limited outpatient bowel preparation with sodium phosphate solution and patient education. Operative modifications included reduced incision length, initial preperitoneal dissection, and the use of internal surgical stapling devices. The postoperative care included the use of prokinetic agents, early nasogastric tube removal, the use of non-narcotic analgesics, and early institution of an oral diet. The outcomes with regard to time to institution of an oral diet, tolerance of a regular diet, and hospital discharge were assessed. RESULTS: The mean surgical time was 3.9 hours, and the mean estimated blood loss was 573 mL. The mean time to the institution of a clear liquid diet was 2.0 days and to a regular diet was 4.2 days. The mean time to hospital discharge was 5.1 days. No statistically significant differences were found in the time to resumption of a regular diet or to discharge between patients undergoing ileal conduits versus orthotopic ileal neobladders. Only 1 patient had any gastrointestinal dysfunction (ileus), and this patient was discharged on postoperative 7. No patient had any delayed complications involving problems with diet intolerance or other gastrointestinal dysfunction. The results of the current series were compared with those of historical controls. CONCLUSIONS: Advancements in preoperative, intraoperative, and postoperative management have together been successfully used in our patient population to reduce morbidity and improve recovery with regard to the early institution of an oral diet and early hospital discharge.

Adult↗

PubMed1990

[Mechanical staplers in exeresis surgery of pulmonary cancer].

Surgical stapling devices are widespread in many branches of surgery and are employed with success in thoracic surgery. Our experience is in line with that of other Authors: stapling of the bronchus is faster, does not contaminate the operative field and reduces the incidence of bronchopleural fistulas (4.76% to 1.59%). Parenchymal stapling is indicated for resection of bullae, metastases and peripheral lesions. The mechanical suture is air-tight and faster than manual suture. Pulmonary vessels may also be closed mechanically; however, we do not advocate the use of stapling devices especially in the closure of the pulmonary artery.

Aged↗

PubMed1982

Clinical efficacy of the stapled anastomosis in esophageal reconstruction.

We have clinically evaluated Russian and American stapling devices used for esophageal reconstruction and compared the results following stapled anastomosis with those following hand-sutured procedures, both performed by the same surgeon. With the Russian stapler, anastomoses performed in 17 patients with carcinoma of the thoracic esophagus resulted in only one (5.9%) anastomotic leak; in 12 hand-sutured anastomoses and in 11 anastomoses done with an American stapler, no anastomotic complication occurred. Thus, a long gastric tube with good blood supply is of paramount importance, and if the technical details of surgical stapling can be overcome, a stapled anastomosis appears to be as safe as a manual suturing for patients undergoing esophageal reconstruction.

Esophageal Neoplasms↗

PubMed1985

Ileal conduit calculi from stapler anastomosis: a long-term complication?

A long-term review of 24 patients in whom ileal conduit diversions were constructed using surgical staples has shown calculi developing as a result of the staples in only 1 patient (4.2%). Experience suggests that calculi usually form within fourteen months of surgery, pass spontaneously, and produce minimal symptoms.

Adolescent↗

PubMed2001

Tensile strength of wound closure with cyanoacrylate glue.

2-Octyl cyanoacrylate tissue adhesive is increasingly being used for closure of traumatic lacerations. Data regarding the strength of incisions closed with 2-octyl cyanoacrylate are limited. We compared the strength of disruption of closure with glue with that of more conventional methods of wound closure. Segments of fresh porcine skin measuring 3.5 x 10 cm were approximated by one of four methods: 1) 2-octyl cyanoacrylate glue, 2) surgical staples, 3) 0.5 inch Steri-Strips, and 4) interrupted 4-0 poliglecaprone 25 sutures in a subcuticular fashion. Fifteen specimens were used to test each type of closure. The strength of closure was tested on an Instron 4502 tensionometer. The peak force required for disruption of the closure was recorded and the strength of the closure was compared. Staples provided the strongest closure. Skin glue proved superior to Steri-Strips but inferior to stapled closure. The difference between skin glue and suture closure was not statistically significant (P = 0.12). Patterns of failure differed between the groups. Skin glue failed because of disruption of the skin-glue interface. 2-Octyl cyanoacrylate glue provides a wound closure that is similar to closure with an interrupted subcuticular absorbable suture. This study validates the clinical use of skin glue for closure of surgical incisions. The technique should be used with caution in areas of the body that are subject to tension.

Animals↗

PubMed2001

Failure strengths of suture vs. biodegradable arrow and staple for meniscal repair: an in vitro study.

A study was performed to determine the in vitro biomechanical behaviour of two 'all inside' meniscal repair techniques (Meniscal Arrow [Bionx Implants Inc.] and Meniscal Staple [Surgical Dynamics Inc.]) and compare these directly with both a horizontal and vertical suture repair. Using 30 fresh bovine medial menisci, vertical 'bucket handle' tears were created 4 mm from the meniscus periphery. Repairs were subsequently performed, using four techniques, with 15 repairs in each group, a horizontally placed 3-metric Ethibond suture, a vertically placed 3-metric Ethibond suture, a single 13-mm arrow and a single 7-mm staple. A tensile test was performed to determine the force at failure for each technique. The mean force at failure of the horizontal and vertical suture groups was 63.2 and 73.9 N, respectively, 44.3 N for the arrow group and 17.8 N for the staple group. The mean forces at failure were significantly different (P < 0.005). The mean tensile strength of the meniscal staple was significantly lower than that of both suture and arrow groups. The 7-mm staple design may not allow adequate interdigitation between the barbed legs and the semicircular collagen fibres of the meniscus.

Absorbable Implants↗

PubMedDate not supplied

[Treatment of sub-levator rectocele by transrectal approach. Value of the automatic stapler with linear clamping].

Surgical treatment of rectocele causing outlet blockage is still a subject of controversy. A retrospective study of eight rectocele repairs endorectally using a surgical stapling device done over a two years period was performed. The most common indication was constipation. All patients underwent in the preoperative period complete physiologic examination including defecography, anorectal manometry, electromyography and colonic transit studies. All patients underwent colonoscopy to exclude an obvious physical disorder. There was no postoperative morbidity and the mean hospital stay was four days. Good functional results were obtained in seven patients with a one year follow-up. Endorectal resection using a stapling device is both a simple and effective technique to treat rectocele associated with difficulty in evacuation.

Adult↗

PubMed1985

Measurement of blood flow through surgical anastomosis using the radioactive microsphere technique.

Two different radioactive microspheres (141Ce and 46Sc) were used to measure blood flow to an area of the large intestine in dogs before and after a surgical resection was performed with surgical staples. The healing of an anastomosis is theoretically related to the blood flow to the anastomotic site. Blood flow studies were conducted in three dogs using this technique. The average blood flow preoperatively was 0.558 mL/minute per gram and 1.04 mL/minute per gram postoperatively. The standard deviation was +/- 0.16. These results indicate a statistically significant (P less than .05) increase in blood flow at the anastomotic site six days after anastomosis when compared with the blood flow to the same area before any surgical procedures.

Animals↗