Biomedical subjects

J W Kobos

Publications and source records attributed to J W Kobos.

6 recordsLinked to original sources

PubMed1999

Gastrointestinal sutureless anastomosis in pigs using absorbable intraluminal stents, stent placement devices, and fibrin glue - a summary.

INTRODUCTION AND METHODOLOGY: To develop a practical gastrointestinal sutureless anastomosis technique, 164 end-to-end and end-to-side anastomoses were performed on the small intestine (SI), large intestine (LI), rectum, esophagus and gallbladder in 109 female Landrace pigs weighing 25 kg and 35 kg. There were 116 fibrin glue (FG) and 48 sutured anastomoses. The end-to-end SI and LI anastomoses were divided into five groups: sliding absorbable intraluminal nontoxic stent (SAINT); SAINT placement device (SAINT-PD); nonsliding SAINT (nST); sutureless stapler (SS); and sutured controls. The SAINT had a sucrose base, with some having reinforcing fibers. RESULTS: No deaths from dehiscence occurred in any group except one FG-cylinder attempt in the colon (technique abandoned). Statistical analysis of gross pathology indices showed no significant group differences. However, trends favored the SAINT in many indices, including grade-0 intraluminal tissue ridge formation (70.8% SI, 84.4% LI) and grade-0 adhesion rates (45.8% SI, 73.1% LI). Histologic examination showed fewer giant cells, less inflammation, less scar tissue formation and faster healing in the SAINT and nST anastomoses than controls. Follow-up of 300-540 days demonstrated no signs of necrosis or stenosis in the SAINT anastomoses. The nST had excellent results; however, it seems impractical in SI anastomoses and unsuitable for LI. CONCLUSIONS: The SAINT-PD has potential for all gastrointestinal sites, but needs larger experimental trials. The SS technique is impractical and had high tissue ridge formation and adhesion rates. These preliminary trials suggest the simplicity, versatility and safety of the SAINT technique; however, the small groups limit result interpretation. The results present a starting point for sutureless FG gastrointestinal anastomosis, and future experimental evaluation with more extensive statistical analyses in larger studies are needed.

Absorption↗

PubMed1995

Primary cutaneous osteosarcoma.

A 78-year-old man had a 1-cm cutaneous nodule on his shoulder; subsequent excisional biopsy showed osteosarcoma. There was no connection to deeper structures, and no primary bone lesion was found. The tumor recurred at the same site 9 months after diagnosis and was reexcised. We believe this to be the first well-illustrated case of primary cutaneous osteosarcoma, which should now be included on the list of sarcomas that may occur in the skin.

Aged↗

PubMedDate not supplied

Sutureless anastomosis of the small intestine and the colon in pigs using an absorbable intraluminal stent and fibrin glue.

A new sutureless anastomosis technique employing a sliding absorbable intraluminal nontoxic stent (SAINT) and fibrin glue with limited (minutes) stump margin pressure is described. Fifty-one (27 small intestine, 24 colon) SAINT anastomoses were performed in 31 Landrace pigs (25-35 kg). Controls consisted of 48 (26 small intestine, 22 colon) continuous single-layer submucosal anastomoses in 26 pigs. SAINTs, which dissolve in about 30-60 min, were formed from heated sucrose and water poured into handcrafted aluminum molds. Follow-up from 7 to 540 days showed no stenosis or anastomotic imperfections in the latter part of the experiment after the SAINT production and surgical techniques were improved. The SAINT group had fewer site adhesions, faster healing, less foreign body reaction, and fewer lymphocytes than the control group. Initial results indicate that the SAINT-fibrin glue procedure may be an effective sutureless anastomotic method from the duodenum to the sigmoid colon.

Anastomosis, Surgical↗

PubMedDate not supplied

Sutureless cholecystojejunostomy in pigs using an absorbable intraluminal stent and fibrin glue.

The absence of foreign bodies in sutureless anastomoses provides faster healing. The first sutureless cholecystojejunostomies were reported by Murphy in 1892. The common bile duct was tied and 11 cholecystojejunostomies plus 12 jejunojejunostomies were performed in 12 Landrace pigs employing sliding absorbable intraluminal nontoxic stents (SAINTs) and fibrin glue. One cholecystojejunostomy was not performed owing to a gallbladder morphologic anomaly. Three animals died of problems unrelated to the SAINT-glue anastomoses. Of the 18 anastomoses in the 9 remaining animals, all were patent at the verification times of 14, 30, 120, and 480 days. Morphologically,there was greater edema and reduced height of the glandular epithelium in the 30-day CJs when compared to the jejunojejunal anastomoses. Results indicate that the sutureless SAINT-fibrin glue procedure is quite versatile and may be utilized for cholecystoenteric anastomoses.

Anastomosis, Surgical↗

PubMedDate not supplied

Gastrointestinal sutureless anastomosis using fibrin glue: reinforcement of the sliding absorbable intraluminal nontoxic stent and development of a stent placement device.

Sutureless anastomosis of the gastrointestinal tract using fibrin glue and sliding absorbable intraluminal nontoxic stents (SAINTs) has two shortcomings, stent shaft breakage and the lack of a transanal insertion device (TID) for low anterior resection. Reinforcement of the sucrose base SAINT (R-SAINT) is described. Sutureless anastomosis is attempted using a stapleless mechanical stapler (SS) and used as preprototype to screen histologically and mechanically for TID anastomoses in the small intestine. Finally, a prototype absorbable head SAINT placement device (SAINT-PD) intended for TID, similar to the SS, is utilized on the small intestine. Fifty-seven Landrace pigs weighing 25-35 kg were used to perform 58 anastomoses, including the small intestine (15 manual, 19 SAINT, 11 SS, 5 R-SAINT, 6 SAINT-PD) and large intestine (2 R-SAINT). All anastomoses performed with the R-SAINT succeeded on the first attempt even if the shaft cracked. The SS technique proved impractical, but the histological screen results from 7 to 60 days did approximate those of corresponding SAINT anastomoses. The SAINT-PD demonstrated operational improvement over the SS, but the histological results were similar to both the SS and SAINT. The advantages of the R-SAINT and SAINT-PD are that they leave no foreign bodies or pressure clamping devices at the anastomostic site. Larger studies may show the R-SAINT and the SAINT-PD to be practical, new surgical tools in sutureless fibrin glue anastomosis.

Absorption↗

PubMedDate not supplied

Sliding, absorbable, reinforced ring and an axially driven stent placement device for sutureless fibrin glue gastrointestinal anastomosis.

Reduced blood flow of from 43 to 71% has been reported in sutured and stapled anastomoses. The sutureless sliding, absorbable, intraluminal, nontoxic stent (SAINT)-fibrin glue anastomotic method, which clamps the stump margins between 2 dissolving surfaces, includes only two stages of temporary compression (about 6 min total using 4 IU/mL thrombin) during the glue application in order to promote vascularization. A SAINT placement device (SAINT-PD) was introduced to facilitate low rectal anastomoses. Morphohistologic results from limited trials using fibrin glue with an untied sutureless stapler technique and a prototype non-gear-driven SAINT-PD, neither having the two dissolvable clamping surfaces of the SAINT, showed a 29 and 25% incidence of intraluminal tissue ridges, respectively. Since these tissue ridges could result in subclinical dilatation or frank stenosis, and the more extensive SAINT trials had an 8% incidence of tissue ridges, redesign of the SAINT-PD was undertaken. Consequently, to improve the anastomotic quality of the SAINT-PD, the sliding absorbable reinforced ring (sucrose base) acting as the second dissolvable surface for the SAINT-PD and a new axially controlled geared SAINT-PD design are described.

Anastomosis, Surgical↗