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PubMed1991

Anastomotic suture materials and experimental colorectal carcinogenesis.

Local tumor recurrence following restorative surgery for colorectal cancer may occasionally result from the promotion of a neoplastic lesion in a zone of proliferative instability adjacent to the anastomosis. The aim of this study was to compare the influence of three anastomotic suture materials, including stainless steel (as a model of surgical stapling), on colorectal carcinogenesis in an experimental animal model. The transmural implantation of stainless steel sutures into the distal descending colon of albino Swiss rats during the postinitiation phase of tumor induction resulted in significantly fewer animals exhibiting perianastomotic tumors 12 weeks later (3 of 21 animals) when compared with either polyamide (Nurolon; Ethicon, Edinburgh, United Kingdom) (14 of 20 animals; P less than 0.001) or polyglycolic acid (Dexon Plus; Davis and Geck, Gosport, United Kingdom) sutures (17 of 21 animals; P less than 0.001). The findings were similar when the same materials were used to resuture a longitudinal colotomy. For both operative procedures, the type of suture material had no influence on the incidence of large bowel tumors distant from the anastomotic site. These results suggest that stainless steel staples may promote fewer perianastomotic large bowel tumors than certain more conventional suture materials and, therefore, may be safely employed in colorectal cancer surgery.

Animals↗
PubMed1979

Z shaped primary colorectal anastomosis using the GIA autosuture for Hirschsprung's disease.

The Duhamel operation for Hirschsprung's disease has won wide acceptance throughout the world. However, this procedure is not without difficulties, and the usual technique of employing various crushing clamps for division of the colo-rectal septum is inelegant, inconvenient and uncertain. This paper presents an operative technique with particular reference to the use of the GIA autosuture surgical stapling instrument in the Z shaped primary colorectal side-to-side anastomosis for Hirschsprung's disease advocated by Ikeda. This is a single and primary procedure, and makes the postoperative care easier and more comfortable for the patients. Experiences with twenty-five patients are reported.

Child↗
PubMed1976

Outpatient heroin detoxification with acupuncture and staplepuncture.

Eighteen heroin addicts were treated as outpatients with acupuncture, electrical stimulation and staplepuncture. Results of treatment were compared with results in two similar groups of 18 persons in whom detoxification was carried out using methadone and propoxyphene napsylate. Withdrawal symptoms were relieved for about two hours in most of the patients after a treatment episode of acupuncture and electrical stimulation. Staplepuncture, which is the manipulation by hand of a surgical staple implanted in the concha of the ear, was reported to relieve withdrawal symptoms at least partially in approximately 40 percent of subjects. In only one person of the group treated with acupuncture or staplepuncture was complete detoxification achieved, compared with 13 and 10 persons, respectively, in the methadone and propoxyphene napsylate groups (p<.001). Use of acupuncture and staplepuncture in outpatient clinics may be limited unless techniques can be found that will relieve withdrawal symptoms for a longer period than that observed in this study.

Acupuncture Therapy↗
PubMed1983

Radiologic evaluation of complications after esophagogastrectomy.

The use of surgical stapling devices has caused renewed interest in the performance of esophagogastrectomy by reducing complications to an acceptable level. This has resulted in a more complicated radiographic appearance of the procedure. Since complications can be devastating, prompt recognition by the radiologist is critical. Sixty consecutive patients undergoing esophagogastrectomy were examined 7 days postoperatively with esophagrams. Forty-seven had been performed using the end-to-end anastomosis stapler. The spectrum of normal postoperative appearances is described. Follow-up examinations were performed in 29 patients. Postoperative complications included leak at a staple line (four), gastric outlet obstruction (two), gastric necrosis (two), and position-dependent problems with gastric emptying (five). Leaks were manifested by pleural effusions and by contrast extravasation, generally at the anastomosis or the distal gastric margin of resection. Late complications included benign strictures (eight), recurrent malignancy (seven), tracheal aspiration (one), reflux esophagitis (two), and bronchoesophageal fistula (two). The presence of a mass greater than 1.5 cm, particularly one extending across the anastomosis, correlated highly with recurrent malignancy.

Adenocarcinoma↗
PubMed1992

Prosthetic replacement of the superior vena cava with a custom-made pericardial graft: an experimental study.

Prosthetic replacement of the vena cava has been disappointing, mainly because of the hemodynamic characteristics of the venous system and the physical properties of the prostheses used. Spiral grafts constructed with autogenous saphenous vein have been the most successful prostheses to date, but their use is limited to replacement of short segments, and intraoperative construction is time consuming. The authors report their experience with a graft constructed of extra-thick bovine pericardium (PX) and surgical staples. Externally stented polytetrafluoroethylene (PTFE) was used as a control. The superior vena cava was replaced in 13 ewes; PTFE was used in 6 (group 1) and PX in 7 (group 2). Mean follow-up was 15 +/- 8 months for group 1 and 13 +/- 8 for group 2. Cumulative graft follow-up totalled 4612 graft-days. There was one graft occlusion in each group. Patency rates (80%) were similar for the two groups. Histologic changes in pericardial grafts were more marked but did not influence patency. This study reports the longest experimental follow-up (maximum 23 months) and graft patency to date for replacement of the superior vena cava. Both types of graft performed excellently.

Animals↗
PubMed1993

Pneumothorax in AIDS patients: operative management.

Acquired immunodeficiency syndrome (AIDS) is a devastating disease. Pneumocystis carinii pneumonia (PCP) is a major clinical manifestation of AIDS. A 2-year experience with eight operations for PCP-associated pneumothorax in seven AIDS patients was reviewed. Initial treatment was tube thoracostomy in all cases. Operation was performed because of inability to expand the lung and/or persistent air-leak. Time from insertion of the initial chest tube to operation was 9-66 days (mean, 33 days). Pulmonary air leaks were closed with surgical staples and/or sutures. Chest tubes were removed 3-16 days after surgery (mean, 8.5 days). There were no cases of postoperative respiratory insufficiency and there were no deaths. Patients were discharged from the hospital 6-18 days after surgery (mean, 13 days). The postoperative hospital stay was substantially shorter than the preoperative period of nonoperative therapy (13 vs. 33 days). Follow-up is complete in six of the seven patients. Three patients died of AIDS 4-8 months after surgery (mean, 6 months). Three patients are alive 7-14 months after operation (mean, 11 months). Operative management of PCP-associated pneumothorax is effective and can be performed with low morbidity and mortality. We conclude that surgery should be considered as an early option in AIDS patients with PCP-associated pneumothorax.

AIDS-Related Opportunistic Infections↗
PubMed2000

Long-term results of low anterior resection with intersphincteric anastomosis in carcinoma of the lower one-third of the rectum: analysis of 31 patients.

INTRODUCTION: Between 1985 and 1996, 190 patients underwent a low anterior rectal resection with coloanal anastomosis for adenocarcinoma of the lower one-third of the rectum. METHODS: This article reports on 31 (17 males) of these patients with a very low localization of the tumor (distal tumor margin 1.3 +/- 0.9 cm above the dentate line). If the function of the sphincter was acceptable and we could exclude tumor infiltration into the sphincter through endosonography, we relocated the resection plane distally into the intersphincteric region to attain an acceptable margin of safety. In all of these cases, it was impossible for us to perform the usual surgical procedure of a mechanical anastomosis by means of a circular stapler. After intersphincteric rectal resection, the anastomosis was handsewn, using interrupted sutures from the perineal approach, 2.5 to 3 cm above the anal verge, implementing Parks' retractor. A protective stoma was performed in all cases. All data were documented prospectively. RESULTS COMPLICATIONS: Postoperative mortality was 0 percent. Postoperatively, none of the patients showed an indication for relaparotomy. The leakage rate was 48 percent. Only 16 percent later needed additional surgery for anastomotic strictures or for rectovaginal fistulas. Long-term observations showed that the anastomosis healed well in 27 patients (87.1 percent). Four patients (12.9 percent) decided to have a terminal colostomy performed (anastomotic stricture, 3 patients; anorectal incontinence, 1 patient). FOLLOW-UP: During the follow-up period of 6.8 +/- 3.7 years, six patients (19.4 percent) developed a tumor progression (9.7 percent local recurrences and 12.9 percent distant spread). The five-year survival rate was 79 percent (Dukes A, 100 percent (n = 18); Dukes B, 67 percent (n = 4); and Dukes C, 44 percent (n = 9)). Continence: One-third of patients developed anorectal incontinence for liquid (29.6 percent) or solid stool (3.7 percent). Average stool frequency was 3.3 times per day. Resting pressure decreased significantly by 29 percent (preoperative, 105 +/- 37 cm H2O and postoperative, 75 +/- 19 cm H2O; P < 0.05), whereas squeeze pressure did not change. CONCLUSION: In selected patients with tumors close to the dentate line, an intersphincteric resection of the rectum may help to avoid an abdominoperineal excision of the rectum with a terminal stoma, without any curtailment of oncologic standards. A protective stoma for three months is advantageous.

Aged↗
PubMed1993

Technique of single-lung transplantation.

The technique of single-lung transplantation at our institution has evolved as our experience has increased over the past 3 1/2 years. This technique is described and illustrated. Surgical staples are used to perform recipient pneumonectomy and provide free access to the hilar structures for anastomoses. The modified, telescoped bronchial anastomosis allows healing while obviating the need for omentopexy as seen in our last 30 bronchial anastomoses.

Anesthesia↗
PubMed1989

Continent urinary diversion in gynecologic oncology.

Pelvic exenteration is a salvage procedure used primarily for recurrent gynecologic carcinoma. Up to the present time, an ileal or colon conduit has been used for urinary diversion and the patient remains incontinent of urine. This is a preliminary report of nine patients with gynecologic carcinoma in whom a continent urinary diversion procedure was performed. A segment of distal ileum, the ascending colon, and part of the transverse colon are used to create the colonic reservoir. The segment of colon is opened along the tenia and folded onto itself. The walls of the ascending and transverse colon are anastomosed to detubularize this segment of bowel and eliminate the transient high pressure of the colon. Surgical staples are used for the anastomosis. The segment of ileum is tapered and three purse-string sutures (2-O silk) are placed at the level of the ileocecal valve to achieve continence. The short segment of ileum is then exteriorized as a stoma through which the patient catheterizes. Antirefluxing, non-tunneled ureterocolonic anastomoses are performed. The anterior wall of the reservoir is closed with absorbable staples. Postoperative urodynamic studies have shown maximum capacity of 750 ml and the area of continence to be at the ileocecal valve where the purse-string sutures are placed. All patients are continent and postoperative radiographs were negative for reflux. Follow-up was 6 to 12 months. The colonic reservoir is a capacious low-pressure system and warrants further clinical trials in patients with gynecologic cancer.

Colon↗
PubMed2004

Axillary thoracotomy versus videothoracoscopy for the treatment of primary spontaneous pneumothorax.

BACKGROUND: A prospective, randomized study was carried out on patients with primary spontaneous pneumothorax, with the aim of determining if video-assisted thoracoscopy is superior to axillary thoracotomy in the surgical treatment of this condition. METHODS: Patients were randomly assigned to two groups; video-assisted thoracoscopy (group A; n = 46) and axillary thoracotomy (group B; n = 44). All fit the established criteria for surgical indication (relapse or persistent air leakage after pleural drainage). In all cases the treatment consisted of apical segmentectomy of the blebs or dystrophic complex and pleural mechanical abrasion. The study evaluated the following factors: postoperative blood loss, respiratory function (maximum inspiratory and expiratory pressures, forced expiratory volume in the first second and forced vital capacity), postoperative pain (analog visual scale), supplementary doses of analgesics, postoperative complications, hospital stay, and resumption of normal activity. Relapses were evaluated for the minimum period of time of two years. RESULTS: No significant differences were found in any of the factors studied in either group. CONCLUSIONS: Video-assisted thoracoscopy and axillary thoracotomy offer similar results in the surgical treatment of primary spontaneous pneumothorax. The rate of complication is low and the level of pain is acceptable without long-term sequelae.

Adult↗
PubMedDate not supplied

Laparoscopic gastric bypass complicated by gastric pouch necrosis: considerations in gastroesophageal reconstruction.

Gastric pouch necrosis and intraabdominal sepsis is an uncommon complication following laparoscopic gastric bypass. The intraoperative management of this complication centers on resection of the necrotic pouch, esophageal diversion, drainage, and enteral access for nutrition. Reestablishing gastrointestinal continuity at a later surgery following this complication can be challenging. We present a case in which the colon was found to be unacceptable for use in reconstruction; the remaining stomach was used as the conduit for a transhiatal reconstruction of gastrointestinal continuity instead.

Adult↗
PubMed1990

Ethanol diffuses across the gastric muscle wall.

Ethanol inhibits the electrical and mechanical activities of gastric smooth muscle, but only at concentrations higher than can be provided by serum delivery. We speculated that the ethanol concentration in the gastric wall may exceed plasma levels by direct diffusion across the mucosa and through the muscle layers. A model of acute ethanol ingestion was created by partitioning the stomachs of three dogs with a surgical stapling device and instilling carbon 14 (14C)-labeled ethanol into the proximal segments. The flux of ethanol was traced by counting 14C in serial sections of the gastric wall. A mucosa-to-serosa gradient of 14C activity was established. The data indicate that direct diffusion from the mucosal surface will produce dramatically higher concentrations of ethanol in gastric muscle than would be anticipated from serum levels alone.

Animals↗
PubMed2001

Evolving concepts in the management of colonic injury.

PURPOSE: The management of colonic injury has changed in recent years. This study sought to evaluate current surgical management of injuries to the colon in a busy urban trauma centre, in the light of our increasing confidence in primary repair and evolving understanding of the concepts and practice of damage control surgery. METHODS: A retrospective analysis was made of consecutive patients presenting with colonic injury from January 1 to December 31 1998. Patients without full-thickness lesions of the colon were excluded, as were patients who died within 24 h of admission. Demographic data, wounding patterns and clinical course were studied. RESULTS: One hundred twenty-seven patients were analyzed. Management without colostomy was achieved in 84% of cases. Patients who underwent diversion of the faecal stream had increased morbidity and hospital stay compared to equivalent patients who were repaired primarily. The important subgroup of patients who underwent damage control or abbreviated laparotomy is discussed. CONCLUSION: This study further strengthens the validity of direct repair or resection and primary anastomosis for colonic injury. Strategies to deal with the subgroup of patients at very high risk of postoperative complications are suggested.

Accidents, Traffic↗
PubMed2003

Argon plasma coagulation: Clinical experience in pediatric patients.

BACKGROUND: Argon plasma coagulation has potential advantages in pediatric endoscopy. METHODS: Argon plasma coagulation was applied in 13 children (age 0.05-17 years; median 3 years) with significant comorbid conditions including immunosuppression, chemotherapy, acute or chronic organ failure, and coagulopathy. Twelve had bleeding lesions; esophageal granulomatous tissue was coagulated in one. The bleeding lesion was located in the stomach in 9 of 12, the duodenum in 2 of 12 (both with granulomatous tissue), and at an enterocolonic anastomosis in 1 of 12. OBSERVATIONS: In total, 23 procedures were performed, 22 for bleeding (range 1-5 per patient). Hemostasis was achieved in 8 of 12 with one session. Blood loss and transfusion requirement were reduced in 3 of the other 4 patients. Blood loss was not affected in 1. Bleeding recurred in 3 of 12, and additional procedures were performed in 7 of 12. Granulomatous tissue was completely eradicated in 2 of 3; in one, granulomatous tissue associated with surgical staples was only partially removed. Complications occurred in 2 of 13 patients and included submucosal argon gas and scar formation. CONCLUSION: Endoscopic argon plasma coagulation is efficacious for hemostasis and tissue ablation in pediatric patients. Minor complications occurred in 17% (2/13) of cases in this series.

Adolescent↗
PubMed1995

Advances in surgery for gynecologic malignancies.

Surgery has a significant role in the management of most gynecologic cancers. Recent developments in the diagnosis and management of ovarian, cervical, endometrial, and vulvar cancer are worthy of addressing in this review. Significant advances have occurred in the understanding of molecular genetic lesions, leading to a predisposition for ovarian cancer that may have a profound influence on prophylactic oophorectomy. Interval debulking surgery may provide a survival advantage for patients with advanced ovarian cancer. The loop electrosurgical excision procedure has become an integral part of the management of preinvasive disease of the cervix. Advances in the application of surgical stapling devices may lead to reduced operative time and blood loss for radical hysterectomy. Recent studies have addressed the adequacy of endometrial biopsy for the evaluation of postmenopausal bleeding. Advances in lymphatic mapping techniques have led to a novel application to the intraoperative identification of the sentinel node in vulvar cancer.

Endometrial Neoplasms↗