[Salpingoclasia by laparoscopy using silastic rings. Comparative analysis of 1,500 cases].
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Adolescent↗
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[Electrofulguration vs tubal occlusion using silastic rings. Analysis of transoperative complications].
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Adult↗
Silastic ring vertical gastroplasty as treatment for morbid obesity: technique and results for 337 patients.
SRVG is an easy and efficient treatment for morbid obesity. It allows spectacular weight loss and by this increases notably the life expectancy. In our series of 337 patients, we have no operative mortality and a morbidity of 5.6%. A permanent multidisciplinary approach is necessary to obtain good results. A more important follow-up has to confirm these encouraging results.
Adolescent↗
Contraceptive vaginal ring--a rising star on the contraceptive horizon.
Two studies were carried out at AIIMS to judge efficacy, side-effects and acceptability of the contraceptive vaginal ring, a Silastic ring with an inner core containing 6.0 mg levonorgestrel mixed with Silastic and an outer core of Silastic only. It releases levonorgestrel at a constant rate of 20 micrograms/day and remains effective for 90 days. The first study of 50 women lasted for 12 months and the second study of 46 women lasted 24 months. Menstrual irregularity in 36% of women was the commonest reason for discontinuation. The majority of women experienced menorrhagia or irregular spotting per vaginum. Vaginal irritation or increased vaginal discharge was the second commonest reason for discontinuation and was noted in 23% of subjects. Repeated spontaneous expulsions accounted for discontinuation in 6% of subjects. No method-related failure was noted in the study. Follow-up study revealed users to be happier with the ring than with any other method and no spouse complained of feeling the ring during coitus. With its ease of administration, absence of gastrointestinal side-effects and a high success rate, the contraceptive vaginal ring is a promising contraceptive method for the last decade of the 20th century.
Adolescent↗
Complications of laparoscopic sterilization. Comparison of 2 methods.
A retrospective study of 5346 cases of laparoscopic sterilization with special reference to early and late complications was undertaken. In the 6-year period from 1972 to 1978, 846 patients were sterilized by the elasticized silicone-ring technique and 4500 patients were sterilized by the electrocautery method. The electrocautery method was complicated by electrical burns in 13 cases (0.29%); 3 of these patients required bowel resections. Mechanical complications occurred in 1.6% of the Silastic-ring cases, but none of the patients required additional surgery. The Silastic-ring patients had greater postoperative abdominal pain than the electrocautery patients, but it usually abated within 48 hours. There were 15 cases of postoperative pelvic infection in the electrocautery group, and none in the Silastic-ring group. Bleeding from the mesosalpinx occurred in both groups and occurred more often with coincident suction D&C. Technical failure to perform the sterilization procedure was principally related to previous abdominal surgery. A substantial number of patients complained of menstrual irregularity and/or dysmenorrhea following these sterilization procedures. The majority of women reported unchanged or improved sexual relations. Improvement in sexual relations was reported by significantly more patients in the Silastic-ring group than in the electrocautery group.
Burns, Electric↗
Vertical ring gastroplasty for morbid obesity. Five year experience with 1,463 patients.
Vertical gastroplasty is a safer and simpler operation than gastric bypass for morbid obesity, but to produce permanent long-term weight loss, a permanent support is needed for the outlet of the newly created gastric pouch in vertical gastroplasty. The most important finding in this study of 1,463 patients with vertical gastroplasties was the development of a safe and practical use of a Silastic ring to permanently support the outlet. Using an uncovered Silastic ring, erosion of the ring has not been observed and long-term weight loss of 36.7 percent of original weight or 63.4 percent of excess weight has been obtained, which is equivalent to that reported for gastric bypass or other gastric reduction procedures. In addition, lower mortality and lower morbidity rates have been achieved than those reported in studies using other gastric reduction methods. Silastic ring vertical gastroplasty with an uncovered ring is the safest and most effective of the gastric reduction procedures in our experience.
Adolescent↗
Contraception by means of a silastic vaginal ring impregnated with medroxyprogesterone acetate.
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Adult↗
Luteinizing hormone-releasing hormone, ovariectomy, and silastic vaginal rings in the Rhesus monkey.
The interaction of estradiol and luteinizing hormone-releasing hormone (LRH) may be a critical physiologic mechanism regulating the occurrence of ovulation in many species. These studies were conducted to assess (1) the effects of intramuscular injections of LRH in the intact female rhesus monkey and (2) the effects of estradiol in a Silastic delivery system in ovariectomized female rhesus monkeys. No changes in blood levels of luteinizing hormone (LH) were detected in response to 200 micrograms of LRH. Ovulation did not occur 48 hours after treatment. Ovariectomy decreased estradiol, increased LH, and had no effect on prolactin concentrations in sera. Insertion of a vaginal ring containing 10% estradiol increased blood estradiol levels 100-fold. Serum prolactin levels were unaffected; however, LH concentrations were altered in a multiphasic fashion. After the ring had been in place for 15 days, vaginal blood similar to menstrual flow was observed following removal.
Animals↗
Quantification of anti-angiogenesis using the capillaries of the chick chorioallantoic membrane demonstrates that the effect of human angiostatin is age-dependent.
We present a method whereby en face estimation of the chorionic capillary plexus can be generated in the living chick chorioallantoic membrane (CAM) and confirmed by post-fixation cross section analysis. This value does not alter significantly with age and provides a reliable and simple method to evaluate anti-angiogenesis. Anti-angiogenesis may be induced by an intervention, such as a pharmacological agent, applied to the surface of the CAM. We describe the use of silastic rings that are associated with minimal inflammatory reaction, in this process. By estimating changes in the chorionic capillary plexus to quantify anti-angiogenesis, together with silastic rings, we examined the anti-angiogenic effect of human angiostatin and demonstrated that although there is a significant loss of capillaries en face after exposure from days 7 to 9 of incubation, in contrast there is no significant inhibition after exposure to a similar dose of angiostatin from days 11 to 13 of incubation. This not only demonstrates the important effects on neo-angiogenesis compared to mature vessels, but also illustrates the potential of the CAM to readily provide a means for such a comparison.
Age Factors↗
The Proring-Band: a new device in the field of restrictive surgery: preliminary experience.
BACKGROUND: We have an 11-year experience with Silastic ring vertical gastroplasy (SRVG) by laparotomy (1991-1994), followed by SRVG by mini-laparotomy (1995-2002), giving a total of 1,286 patients up to May 31, 2002. Searching for optimal results, we have utilized a new device; the Silastic ring has been replaced by the Proring-Band. METHODS: 174 mini-laparotomy SRVGs (mini-SRVG) were carried out with the Proring-Band from July 16, 2001 to May 31, 2002. RESULTS: The ring is more flexible, slightly elastic and white-colored. At the operation, handling, fixing to the stomach and extraction were easier. No immediate postoperative complications or overall morbidities were related to the new band. No side-effect has been noted. CONCLUSIONS: The Proring-Band appeared simpler in its use, during preparatory extra-body handling, placement and fixation. Considering its flexibility, its flat part and its smooth edges, the Proring-Band appears to present less risk of dysphagia, rupture and migration. This situation will be evaluated in a comparative blind study with a follow-up of more than 2 years. The Proring-Band ring is manufactured, sterilized and marketed by a pharmaceutical company. The use of this ring, provided as a medical device designed for restrictive surgery, assures to the surgeon a reproducibility of the material and of the sterilization conditions.
Dimethylpolysiloxanes↗
A technique for laparoscopic pomeroy tubal ligation with endoloop sutures.
A laparoscopic technique of Pomeroy tubal ligation using endoloop sutures was compared with the conventional technique of laparoscopic tubal ligation with Silastic rings. Fifty-three patients selected from a population undergoing tubal ligation were randomized to either the Pomeroy (N = 28) or ring (N = 25) group. Mean (+/- standard deviation) operative time for the Pomeroy group was 27.39 +/- 5.95 minutes, with a range of 18-40; for the ring group, the time was 23.11 +/- 11.53 minutes, with a range of 12-58. These times were not statistically different. Operative complication were encountered only in the ring group and included two lacerations of the mesosalpinx. There were no technical or method failures over a follow-up interval of 12-18 months. Specimens confirmed tubal histology in all cases in the Pomeroy group. Laparoscopic Pomeroy tubal ligation using endoloop sutures was easily performed, comparable to laparoscopic application of Silastic rings, and provided a surgical specimen to confirm tubal histology. This aspect may represent a medicolegal advantage of documentation not available with other laparoscopic techniques of tubal ligation.
Adult↗
Vertical banded gastroplasty.
VBG and vertical Silastic ring gastroplasty are simple gastric restriction procedures that have defined technical standards. Two recent improvements in the operation have been the development of the six-row endolinear cutting-stapling instrument that divides the vertical partition without an increase in GI leakage and the application of minimally invasive laparoscopic techniques that have reduced the incidence of incisional hernia to less than 1%. VBG and vertical Silastic ring gastroplasty are procedures that can effectively help select patients to manage their morbid obesity. However, these procedures are critically dependent on patient compliance. It is not possible to know preoperatively whether a candidate will make the lifelong behavior modifications necessary for sustained weight loss. Experience has demonstrated that bariatric surgeons have limited control over a patient's level of motivation for compliance.
Contraindications↗
Contraceptive effect of varying dosages of progestogen in silastic vaginal rings.
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Acetates↗
Low-dose intravaginal estradiol delivery using a Silastic vaginal ring for estrogen replacement therapy in postmenopausal women: a review.
OBJECTIVES: The aim of this study was to review the potential of the intravaginal ring to be an effective low-dose estrogen delivery system for the treatment of postmenopausal women. METHODS: The data were extracted from the literature using the computerized MEDLINE system. The soft and flexible ring (Estring(R)) is made of silicone rubber with a 55-mm outer diameter and 9.5-mm cross-sectional diameter, contains 2 mg 17beta-estradiol in the core section with the release specification limit of 6.5-9.5 microg/24 h and maintains a continuous plasma estradiol concentration of 20-30 pmol/l for 3 months when inserted in women. RESULTS: Comparative clinical trials have demonstrated that treatment with the intravaginal ring is excellent at alleviating subjective and objective symptoms of estrogen deficiency, restores vaginal mucosa, induces a high maturation index of mucosal cells and reduces vaginal pH to < 5.5 in postmenopausal women. No major side-effects or endometrial proliferation have been observed during treatment. The majority of patients prefer using the vaginal ring to other currently available vaginal steroid delivery systems. The sustained low-dose estrogen therapy is also found to improve the serum lipid profile in elderly women. CONCLUSIONS: It is suggested that the low-dose estradiol intravaginal ring is safe, effective and well accepted for the treatment of estrogen deficiency symptoms in postmenopausal women.
Aged↗
[Surgery of morbid obesity: intestinal bypass to adjustable gastric banding].
The authors present their experience at the Centre for the surgical treatment of morbid obesity at Milano University where since 1974, 603 obese patients underwent surgery: 312 jejuno-ileal bypass (JIB), 70 bilio-intestinal bypass (BIB), 102 horizontal gastroplasties (HGP), 44 silastic ring vertical gastroplasties (SRVGP) and 75 adjustable silastic gastric banding (ASGB). Average follow-up for these procedures is 16, 6, 11, 4 years and 24 months respectively. Weight loss is satisfactory in all cases even though the percentages vary in the different procedures. The most serious complications (severe hepatic failure, oxalic interstitial nephritis, persisting malabsorption) occurred in patients submitted to JIB. The best clinical outcome with the lowest complications rate was obtained with BIB compared to other intestinal bypasses. The most frequent complication observed in patients submitted to gastroplasties was incoercible vomiting while the most severe complications were diffuse peritonitis, secondary to gastric perforation, and peripheric neuropathy. Our experience confirms that surgical treatment of morbid obesity refractory to medical therapy is today a safe and effective treatment. BIB has still a role in super-obese young patients (BMI over 50) refusing dietary restriction lifetime. The gastric procedures, especially laparoscopic ASGB, seem to be the best option. The excellent outcome of bariatric surgery can be obtained only in specialized centers where various specialists work together.
Adolescent↗
Laparoscopic sterilization with electrocautery, silastic bands and spring-loaded clips: report of our experience with 790 patients.
A comparative study was carried out in 790 women undergoing one of the 3 most frequently used laparoscopic sterlization techniques: high-frequency unipolar electrocoagulation of the tubes, application of silastic rings or spring-loaded clips to the tubes. The technical problems and per- and postoperative (early) complications are assessed. The use of high-frequency unipolar current has been superseded by today's mechanical and non-electrical sterilization methods. The spring-loaded clip method appears to be a sterilization technique with a minimum of severe complications, and theoretically the greatest chances for possible refertilization.
Electrocoagulation↗
Tubal ring sterilization: experience with 10,086 cases.
The safety and efficacy of the Silastic ring were examined for interval, postabortion, and postpartum sterilizations. The study includes an in-depth analysis of 10,086 cases generated by 51 collaborating institutions in 23 countries. Failure of the tubal ring is studied via the life-table method, although follow-up is limited to a relatively short period. Difficulties encountered when applying the ring, particularly those resulting in technical failure, are explored in detail. Surgical complications, infection, menstrual irregularity and abnormal bleeding, and pelvic surgery following sterilization are discussed. Comparisons are made among various approaches to the fallopian tubes. Such data are found to be similar to those for other occlusion techniques, demonstrating the comparable safety and efficacy of tubal ring sterilization.
Actuarial Analysis↗
Two cases of conversion of vertical ring gastroplasty to adjustable silicone gastric banding.
BACKGROUND: Since May 1995, we have used laparoscopic adjustable silicone gastric banding (ASGB) as an alternative to silastic ring vertical gastroplasty (SRVG) to treat morbid obesity. Moreover, it seemed that ASGB was an appropriate procedure to use when SRVG had failed and no alternative procedure could be attempted again, which occurred in two patients. Because of adhesions, the laparoscopic approach was inappropriate in both cases. The size of the pouch and the staple-line were not obstacles to ASGB. METHODS: Case 1 was a 53-year-old woman of 111 kg (BMI = 46) who had SRVG in July 1994. One year later, she had a 54 kg weight loss, but had continuing food intolerance, although malfunction of the pouch or ring could not be found. A removal of the ring was performed in October 1995, and a 10-cm diameter silicone band placed. The band was not inflated until she had regained weight 5 months later. Case 2 was a 33-year-old woman of 100 kg (BMI = 40) who had SRVG in March 1994. Weight loss was 45 kg 18 months later; then she gained weight. Endoscopy and barium swallow showed both staple-line disruption and band erosion. Removal of the ring was performed in March 1996, and a 9.75-cm diameter silicone band placed, and inflated at the same time with 2 cc saline. RESULTS: Both patients are doing well. CONCLUSIONS: ASGB appeared to be the best alternative when revising an SRVG in cases where a new stapling or the placement of a new ring could have had consequences more serious than the primary complications.
Adult↗