Colon resection using the invagination technique.
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Animals↗
Biomedical subjects
B Ravo
Publications and source records attributed to B Ravo.
A new technique for indirect inguinal hernia repair.
This report concerns a preliminary study of a new technique for indirect herniorraphy, which was used in 242 patients from December 1988 through March 1991. Its main characteristics are the creation of a deep neo-inguinal ring in a more medial site, shortening of the inguinal canal by transposition of the superficial ring to the point where the inferior border of the internal oblique muscle is well represented, reinforcement of the inguinal canal by overlapping the external oblique aponeurosis in a double-breast fashion, and maintenance of the cremasteric muscle. Follow-up in our outpatient clinic was carried out at 1, 6, 12, and 24 months in 71% of our patients. There were no recurrences, except for one crural pseudo-recurrence, no mortality, and no testicular atrophy. Thirteen percent of patients had subcutaneous serous collection; 1% had hematomas; 2% temporary testicular edema; and 0.4% wound infection.
Abdominal Muscles↗
[Aseptic resection of the intraluminal colon in laparoscopy].
Laparoscopic surgery is an "old" technique extending to new applications including colon surgery. Basically, even though surgical technique and indications do not differ from traditional surgery, it has the advantage to eliminate most of the complications associated with an abdominal incision. In order to improve also the outcome of intestinal anastomoses, an aseptic technique by intestinal intussusception previously described (3) has been modified and carried out laparoscopically in 3 pigs and 3 dogs successfully. The animals were sacrificed after 2 months. Anastomoses were evaluated endoscopically by barium enema and by gross and microscopic examination. Results indicated no mortality or complications except for a small area of mucosal peri-anastomotic necrosis in one dog, which spontaneously healed. Therefore, it seems that the aseptic resection of the colon is possible with laparoscopy obtaining at the same time a decreased morbidity related to the abdominal incision and colonic anastomosis.
Anastomosis, Surgical↗
Modern operative thoracoscopy.
Laparoscopic surgery has demonstrated advantages of less pain, early recovery, and cosmesis. Applying laparoscopic surgical techniques to thoracic procedures may allow for similar advantages. New instrumentation provides for greater versatility in treating thoracic conditions. Described herein is the use of thoracoscopy for a variety of thoracic procedures.
Biopsy↗
Insertion of the Coloshield through a colotomy after completion of a colonic anastomosis.
A modified technique of an intracolonic bypass procedure after an anastomosis has already been completed is described. Its use would be in place of those situations where the surgeon is contemplating protecting the completed anastomosis with a temporary colostomy/ileostomy.
Anastomosis, Surgical↗
Effect of fecal loading with/without peritonitis on the healing of a colonic anastomosis: an experimental study.
An experimental randomized prospective study was carried out in 64 dogs to evaluate the effect of intraluminal fecal matter at the anastomosis with/without peritonitis on the healing of a colonic anastomosis. The animals, none of whom had bowel preparation, were randomized in four groups: group I sigmoid resection and anastomosis, group II sigmoid resection and intraluminal fecal diversion from the anastomosis, group III induced fecal peritonitis, sigmoid resection and anastomosis and group IV induced fecal peritonitis, sigmoid resection and intraluminal fecal diversion from the anastomosis. Forty-eight hours before sacrifice at 5, 10 and 15 days, 10 microCi/kg C14 proline was given intravenously. Specimens were analyzed for hydroxyproline content, tissue counts and specific activity. The tissue counts and specific activity were analyzed by three-way analysis of variance. Overall, regardless of the groups, there was a statistically significant decrease in specific activity and tissue count from day 5 to day 15 and day 10 to day 15 at the anastomosis (p less than 0.05). When comparing groups II and IV to groups I and III, there was a significant increase in specific activity and tissue count at the anastomosis of group II and IV (p less than 0.05). This experimental study demonstrates that early anastomotic healing can occur even in presence of treated peritonitis as long as the fecal matter is diverted and prevented from coming in contact with the anastomotic site without disrupting the bowel continuity or function.
Anastomosis, Surgical↗
The use of absorbable staples for construction of a bladder tube.
Stapling instruments have been widely used in general surgery but not in the surgical treatment of the urinary tract. The stapler Poly CS-57 (Auto Suture, U. S. S. C.) with absorbable staples has been evaluated in the construction of ten bladder tubes for ureteral substitution in three dogs and six pigs. The dogs and pigs were sacrificed at two, three and six months. There was no mortality rate, no infections, no suture leakages and no crystal or stone formation. There were three instances of ureterovesical anastomotic stenosis. It appears that the absorbable staple can be safely used in urologic operations and that the use of the Poly CS 57 stapler for the construction of a bladder tube makes the procedure safer, simpler and faster.
Absorption↗
[Partial splenectomy using a stapler and the role of regeneration of the residual splenic stump].
Current evidence indicates that only complete or partial intact spleen can protect the organism against pneumococcal sepsis. What is not clear is the amount of minimal splenic tissue needed to protect the organism against such infection. This study has been carried out on 20 dogs which underwent partial or total splenectomy with stapler. Animals were divided into 8 groups according to the quantity of the remnant splenic tissue: 0% (4 dogs); 5% (4); 15% (1); 25% (1); 35% (2); 50% (2); 75% (2); 100% (4), and were followed up for 6 and 12 months. No mortality or bleeding was registered. Results showed a splenic regeneration, histologically demonstrated as an increased number of germinal follicles, in 12 out of 16 dogs, more evident in the animals sacrificed at one year. In conclusion, even a small amount (5%) of splenic tissue preserved with its blood supply can regenerate and acquire with time enough immunological function to protect the organism against post-splenectomy sepsis.
Animals↗
The value of endoluminal ultrasonography and computed tomography in the staging of rectal cancer: a preliminary study.
A prospective study was carried out in 14 patients with rectal cancer. Tumors were staged preoperatively by endoluminal ultrasonography (EU) and computed tomography (CT). Patients were followed postoperatively for 2 years by the same modalities. Extramural spread was 100% (9/9), accurately assessed by EU and 77.8% (7/9) with CT. Lymph node sensitivity was 87.5% for EU and 37.5 for CT (P less than 0.05). Overall accuracy of lymph node metastases was 85.7% for EU and 57.1% for CT (P less than 0.1). In conclusion, the study shows EU to be statistically more accurate for nodal metastases than CT; therefore, its routine use can be recommended in the preoperative staging of rectal carcinoma in those patients for whom a sphincter-saving procedure is considered.
Female↗
Colonic anastomotic leakages.
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Anastomosis, Surgical↗
[A bladder tube construction using a stapler with absorbable stitches (Poly CS-57)].
A new technique for the construction of a bladder tube, using a Poly CS-57 stapler, has been tested on six pigs. With this procedure the operative time is shortened without complications. In fact, no crystal formation, dehiscence or infection was observed during a 3 month follow-up.
Animals↗
The importance of intraluminal anastomotic fecal contact and peritonitis in colonic anastomotic leakages. An experimental study.
An experimental, randomized, prospective study was performed in 64 dogs to evaluate the effect of fecal loading, solely, or in combination with induced peritonitis, on colonic anastomosis. The animals, none of which had bowel preparations, were randomized into four groups. Group I underwent sigmoid resection and standard open end-to-end anastomosis; Group II underwent sigmoid resection and an intracolonic bypass procedure; Group III underwent experimentally induced fecal peritonitis, sigmoid resection, and anastomosis; Group IV underwent induction of fecal peritonitis, sigmoid resection and an intracolonic bypass procedure. Using Fisher's exact test, results indicate a more statistically significant increased leak rate in Group III than in Group II (P = .04), and Group III than in Group IV (P = .03), but no statistically significant anastomotic leak rate between the peritonitis (III and IV) and the nonperitonitis (I and II) groups. A very significant statistical increase in leak rate (P = .002) was observed when comparing the 25 percent leak rate of Groups I and III (anastomosis subjected to fecal contact) with the 0 percent leak rate of Groups II and IV (anastomosis excluded from fecal contact) regardless of the peritonitis. This study suggests that the intraluminal contact of fecal loading at the colonic anastomosis is a more significant factor in anastomotic complications due to dehiscences than peritonitis per se. It follows, therefore, that if feces can be excluded from intraluminal contact with an anastomotic site, an anastomosis can be safely performed even in the presence of treated peritonitis.
Anastomosis, Surgical↗
Preoperative and postoperative evaluation by manometric study of the anal sphincter after coloanal anastomosis for carcinoma.
The purpose of the present study was to pre- and postoperatively evaluate the anal sphincter after coloanal anastomosis in 20 patients with carcinoma of the rectum at 5.5 to 8 cm from the anal verge. The 20 patients matched age and sex with the controlled subjects. Of the 20 patients, 17 with normal preoperative manometric studies when compared with control subjects underwent a coloanal anastomosis as described by Castrini, and three patients with preoperative incontinence underwent abdominoperineal resection. Manometric studies preoperatively, and postoperatively at three and 12 months, indicated a statistically significant decrease in squeezing pressure, and rectal compliance at three months that almost normalized by 12 months. The rectal compliance correlated with the number of bowel movements per day at three months (four to five per day) and at 12 months (two to three per day). The rectoanal reflex and length of pressure zone have remained unchanged. Results seem to indicate that anal continence can be preserved after coloanal anastomosis.
Adult↗
Modified technique of sphincteroplasty with the use of a specially prepared cannula.
A modified technique of sphincteroplasty with the use of a specially prepared cannula can exclude the pancreatic duct from the operative field by covering it with the posterior wall of the cannula. The use of the cannula can avoid some of the technical difficulties that may be encountered with operations involving the papilla of Vater. Our experience with 51 patients has been presented.
Adult↗
Colorectal neurovasculature and anal sphincter.
The varied blood supply of the colon and rectum has been described. It may be stated that the efficiency of any surgeon's hand is primarily dependent on the knowledge that guides it. Significant anatomic facts are described herein. An important blood supply to the terminal ileum comes from the generally unknown ileal artery, which, when absent, creates a critical, poorly vascularized area and thus an inappropriate area for an anastomosis. This right colic artery may be absent in 2 per cent. It may arise in common with the middle colic trunk (52 per cent). The middle colic artery is absent in 3 per cent. It occurs as a separate branch in 44 per cent and may be derived from celiac artery rarely. The inferior mesenteric artery divides into the left colic, which ascends to the splenic flexure, and a descending branch that continues downward as the superior rectal artery. The left colic artery may not reach the splenic flexure. The marginal artery may be interrupted or weakly represented at the splenic flexure. Therefore, one should perform a ligation of the left colic vessel before its bifurcation if the splenic flexure is to be preserved. The superior rectal artery is the main blood supply of the rectum. Its branching on the rectum is varied, but it has a rich anastomosis with the other rectal arteries, namely, the middle rectal and inferior rectal arteries. Sudeck's point is not critical. The middle rectal artery varies in number and origin and is not essential provided the inferior rectal artery is intact. The anatomy of the anal canal is described. The rectum is for a short distance surrounded by the anal canal with the external sphincter. The internal sphincter is the end of circular muscle of the rectum. The external sphincter can be thought of as one continuous muscle divided by longitudinal bands into three main parts: subcutaneous, superficial, and deep. Below the pectinate line in the anal canal, the nerve supply, lymphatic drainage, blood supply, and epithelium are different from that in the rectum.
Anal Canal↗
Diagnostic anorectal functional studies. Manometry, sphincter electromyography, and defecography.
Anorectal manometric and electromyographic studies assess anorectal and pelvic floor neuromuscular disorders and can help in the diagnosis and management of incontinence, prolapse, megarectum, and other functional anorectal disorders. These studies can assess preoperative and postoperative anorectal function and help in the differential diagnosis of anorectal disorders, and thus they assist the surgeon in carrying out rational therapy.
Anal Canal↗
Colorectal anastomotic healing and intracolonic bypass procedure.
Intestinal anastomoses continue to be complicated by leakages even in the best of hands despite the development of new surgical techniques, suture materials, devices, and stapling instruments. One may explain such persistence of anastomotic leakage on the basis of the dynamic effect that multiple factors have on the healing of an anastomosis. Awareness of these factors and proper precautions by the surgeon can make a high-risk anastomosis less prone to leakage. The intracolonic bypass procedure is an alternative to a temporary colostomy. It does not prevent an anastomotic dehiscence but can prevent anastomotic leakage with its associated complications in those situations where dehiscence is most likely to occur.
Aged↗