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PubMed1994

Arthroscopic reduction and fixation of a completely displaced fracture of the intercondylar eminence of the tibia.

A simple method of arthroscopic reduction and fixation of a fracture of the intercondylar eminence of the tibia is described. A 23-year-old man with a completely displaced (Type IIIB) fracture was treated with arthroscopy. A satisfactory reduction was achieved by releasing the medial meniscus, which was entrapped in the fracture site. Link dynamic staples (W. Link, Hamburg, Germany) were used to firmly fix the fracture when the guide tube came downward from the medial mid-patellar portal. The secure fixation of the fragment and the prevention of the need for an arthrotomy facilitated early functional rehabilitation. One year after surgery the patient had a stable, painless joint with a full range of motion. The described method is technically straight-forward and can provide secure fixation of a bone fragment. The Link staples are useful in the fixation of a displaced fracture of the intercondylar eminence of the tibia.

Adult↗
PubMed1994

Evaluation of staples and prostheses for use in laparoscopic inguinal hernia repair.

With the increasing popularity of laparoscopic prosthetic inguinal hernia repair, it was decided to compare the various staples and prostheses currently in use. A twofold increase in breaking or opening strength was required to disrupt the Endoscopic Multifeed Staple (31.2 Newtons vs 15.6 Newtons) compared with the Multifire Endo Hernia Staple. A linear relationship existed between the number of staples used and the maximum load tolerated. No significant difference was found between the breaking strength of the prostheses evaluated. Further research into the biomechanics of laparoscopic inguinal hernia repair is necessary to determine how important staple and prosthesis strength is for the success of the repair.

Hernia, Inguinal↗
PubMed1999

Comparison of staples versus sutures in the repair of penetrating cardiac wounds.

BACKGROUND: Several literature reports advocate the use of skin staplers for repair of penetrating cardiac wounds during emergency thoracotomy. Our study goal was to objectively determine if stapling is a more efficient method of closure compared with suturing without compromising the strength of the repair. METHODS: This randomized, nonblinded study was conducted in a swine model. A total of four incisions, two per ventricle, were made in each animal. The 2-cm full-thickness incisions were repaired with either sutures or staples, and the time required to close each wound was recorded. After wound repair, the animals were killed. The four wounds were isolated by removing 4.0-cm strips of myocardium oriented perpendicular to the incision. Each strip was then placed on a tensile force testing machine, and the breaking strength of the sutures and staples was measured. RESULTS: The tensile force test showed that stapled and sutured wounds have equivalent mechanical strength. The mean time of closure for stapled wounds was substantially less than that for sutured wounds. CONCLUSION: In this swine model, stapling took significantly less time and had equal mechanical strength compared with suturing for repair of penetrating cardiac wounds. Stapling during emergent resuscitation may be preferable to suturing.

Animals↗
PubMed2004

Advanced lung cancer invading the left atrium wall treated with pneumonectomy and combined resection of the left atrium using stapling devices: report of two cases.

In chest surgery, stapling devices are primarily used to close bronchi. However, they are also used for dissection and suturing between lung lobes, resection and plication of lung tissue (including bullae), combined resection of the superior vena cava, closure of the pulmonary great vessels, closure of the left atrium following combined resection of the left atrium, and so on. We recently treated two cases of advanced lung cancer, which had invaded the left atrial wall, with pneumonectomy and combined resection of the left atrium using stapling devices, and obtained favorable results. For combined resection of the left atrium, it is safer to use stapling devices than vascular clamps, since the latter involve the risk of dislocation during use. Furthermore, since stapling devices require no margin for suturing, the left atrium can be resected at a point sufficiently distant from the cancer, thus allowing for highly radical resection. Stapling devices are also useful because they can be manipulated even within narrow operative fields. When dealing with lung cancer requiring combined resection of the left atrium, pneumonectomy is needed in most cases. When performing surgery for these cases, it is essential to first close and divide the bronchi and pulmonary arteries and veins as far as possible so that adequate adherence around the left atrium can be developed and the entire lung can be lifted up, followed by resection of the left atrium with a stapling device applied to the left atrium without any tension.

Aged↗
PubMed2005

Bioabsorbable staple line reinforcement for laparoscopic gastrointestinal surgery.

Laparoscopic gastrointestinal (GI) surgery often requires transection and reconstruction of the GI tract and division of vascular pedicles. Intraoperative staple line bleeding and postoperative GI hemorrhage are reported complications. Prevention of staple line bleeding includes oversewing of the staple line or more recently the use of staple line reinforcement sleeves as an adjunct on the stapler. The results of bioabsorbable glycolide copolymer sleeves (Seamguard, W.L. Gore & Associates, Inc., Flagstaff, AZ, USA) as staple line reinforcement during 44 laparoscopic GI operations were reviewed. The charts were analyzed retrospectively for demographics, quantity of staple line reinforcement material used, operative time, blood loss, intraoperative complications, postoperative bleeding or leak, and serial hemoglobin. The study group of 44 patients included 17 males and 27 females, with a median age of 44 years. The laparoscopic GI operations performed were laparoscopic cystgastrostomy (n=1), esophagus cancer staging (n=2), esophagectomy (n=2), colectomy (n=3), gastrectomy (n=5), appendectomy (n=9), and Roux-en-Y gastric bypass (n=22). The median number of staple line reinforcement sleeves used per operation was one for appendectomy and laparoscopic cancer staging, five for gastrectomy and esophagectomy, and seven for gastric bypass and colectomy. The mean blood loss was 86 +/- 22 mL. No intraoperative staple line disruptions occurred. Intraoperative staple line bleeding was minimal and few staple lines required oversewing. One patient developed GI hemorrhage on postoperative day five after being involved in a motor vehicle accident. The mean hemoglobin decreased from 13.9 +/- 1.6 g/dL at baseline to 12.6 +/-1.4 g/dL on the first postoperative day. No postoperative leaks or abscesses occurred. This study demonstrates that bioabsorbable glycolide copolymer staple line sleeves is safe and effective in prevention of intraoperative staple line bleeding and postoperative GI hemorrhage in 44 intra-abdominal GI operations.

Absorbable Implants↗
PubMed2006

[Perirectal, retroperitoneal, intraperitoneal and mediastinal gas after stapled haemorrhoidopexy].

We describe a case of perirectal, retroperitoneal, intraperitoneal and mediastinal gas after stapled haemorrhoidopexy. A previously healthy man aged 38 suffered after the operation from abdominal pain and scrotal emphysema. Anorectoscopy revealed a technical failure, as the staple line was found 6-7 cm orally to the dentate line. The patient was successfully treated with intravenous antibiotics and oxygen and recovered without further surgery. In case of alarm symptoms such as abdominal pain or fever after stapled haemorrhoidopexy, a plain abdominal X-ray should be done to verify or exclude retroperitoneal gas.

Adult↗
PubMed1993

Neovascularization of canine sutured and stapled small intestinal anastomoses.

New blood vessels develop as a gastrointestinal anastomosis heals. The morphologic aspects of this neovascularization were studied in 22 dogs, each of which underwent one sutured and one stapled small bowel anastomosis. At intervals ranging from three to 24 days after surgery, the dogs were killed, and the bowel was injected with Batson's compound or india ink. The pattern of vascular growth across the anastomotic site was studied. Both stapled and sutured anastomoses caused an increase in submucosal capillary density at day three compared with control specimens taken from bowel remote from the anastomotic site. This increase was maintained consistently through day 24 in sutured anastomoses but had decreased by day five in stapled anastomoses. Growth of submucosal vessel across the anastomotic site could be demonstrated by day three in sutured and day four in stapled anastomoses. The more vigorous inflammatory response associated with sutured anastomoses may be responsible for more rapid and prominent neovascularization.

Anastomosis, Surgical↗
PubMedDate not supplied

The use of skin stapling in podiatric surgery: a review and update.

The ideal method for wound closure remains an enigma. This paper presents a review and the authors' experience of the use of skin staples in podiatric surgery. Little has been written on this topic in the podiatric literature. Skin staples have been shown to provide desirable cosmetic results, a decreased incidence of infection, and a decrease in overall cost as compared with suture.

Dermatologic Surgical Procedures↗
PubMed2007

Special anoscope for easy purse-string suture application in stapled hemorrhoidopexy.

BACKGROUND: Internal hemorrhoids and loose rectal mucosa may block exposure during the purse-string suturing in stapled hemorrhoidopexy, and this may lead to complications. MATERIALS AND METHODS: To retract the prolapsing rectal mucosa, we modified the purse-string anoscope of the PPH01 kit (Ethicon-Endosurgery, Cincinnati, OH, USA) and produced a special anoscope. The open part of the purse-string suture anoscope is covered by transparent acrylic (Orthoacryl, Dentaurum, Pforzheim, Germany). The covering had completely cylindrical outer and inner surfaces and was thin enough to let the anoscope easily rotate in the anal dilator and to let the 26 mm curved, round-bodied needle of the 2/0 polypropylene suture move in the anoscope. A window, 3 cm long and 3-4 mm wide, was opened at the angled part of the anoscope 2 cm to the tip. This special anoscope was used for the purse-string suture during the stapled hemorrhoidopexy procedure in five patients. RESULTS AND CONCLUSIONS: No postoperative complications, early or late, were encountered, and we propose that stapled hemorrhoidopexy procedure can be applied more easily by using this special anoscope.

Equipment Design↗
PubMed2006

Adaptation of the pursestring suture anoscope with a small hole in a case of stapled hemorrhoidectomy.

PURPOSE: Stapled hemorrhoidectomy has become more popular with the general surgeon, mainly because of reduced postoperative pain and shorter hospital stays. However, we have faced some complications caused by irregular pursestring suture of the rectal mucosa. METHODS: To secure pursestring suture in the rectal mucosa layer, we placed a small hole in the Pursestring Suture Anoscope. RESULTS: Since 2001, we have experienced more than 200 cases of stapled hemorrhoidectomy and in the last two years we have performed pursestring suture by using a Pursestring Suture Anoscope with a small hole in 60 cases. Rectal mucosa was resected without irregular defect in all the cases. CONCLUSIONS: Stapled hemorrhoidectomy can be performed easily and safely with this modification.

Equipment Design↗
PubMed1999

Techniques and complications of ileostomy takedown.

OBJECTIVE: We use a loop ileostomy for temporary fecal diversion because of ease of technical construction and assumed low complication rate. Here, we review our complications of loop ileostomy and takedown using three techniques of closure. METHODS: We reviewed charts of all patients who had temporary ileostomies constructed during 1987 to 1995 (n = 366). Ileostomy takedown was performed in 339 patients using one of three closure techniques: enterotomy suture (65%), resection with handsewn anastomosis (20%), and stapled anastomosis (15%). Complications were recorded for pre-takedown and 30-day post-takedown intervals. RESULTS: Overall complication rate was 28%. Pre-takedown complications occurred in 21 patients (5.7%), including small bowel obstruction (2.5%) and dehydration/electrolyte derangement (2.2%). Post-takedown complications occurred in 83 patients (24.5%), including wound infection (14.2%), small bowel obstruction (5%), anastomotic leak (2.9%), and 1 death from a cardiac event. Post-takedown obstruction was higher for closure using resection with sutured anastomosis (12%) compared with enterotomy suture (2.3%), P < or = 0.003. Stapled anastomosis had an intermediate rate of obstruction (7.7%). Anastomotic leak was similar between closure techniques. CONCLUSIONS: Loop ileostomy and takedown are associated with low rates of serious complications (5% or less). As such, we continue to advocate use of loop ileostomy as a diversion procedure. Closure by enterotomy suture is preferred over resection. However, if resection is required, closure by stapled anastomosis is preferred over suture anastomosis.

Adolescent↗
PubMed1996

A comparison of the W-stapled ileal reservoir with hand-sewn reservoirs for orthotopic bladder replacement.

OBJECTIVES: Confidence has increased in the use of an orthotopic reservoir to the urethra after a cystoprostatectomy for bladder cancer; however, many surgeons would welcome a method to simplify the operative procedure. The availability of absorbable staples on a GIA stapler allows study of the incorporation of stapling procedures into formation of a reservoir. Because of the success of hand-sewn W-configured ileal reservoirs, we initiated a Phase II study to evaluate absorbable staples in formation of a W-configured reservoir. We now present an expanded contemporary series comparing a W-stapled ileal neobladder with hand-sewn ileal (Studer) or hand-sewn ileocolic (Le Bag) reservoirs. METHODS: Forty-five selected patients underwent orthotopic urinary diversion after cystoprostatectomy for bladder cancer (n = 42) or prostate cancer (n = 3) using one of the three methods of reservoir construction. There were 43 men and 2 women. The evaluation included a urodynamic evaluation and a questionnaire sent to patients inquiring about urinary function. RESULTS: Most patients did well with the W-stapled ileal reservoir but 6 of 19 evaluable patients had unsatisfactory reservoir characteristics. Three patients needed an augmentation cystoplasty and 3 had higher pressure, smaller volume reservoirs. Reservoir function appeared to be consistently more favorable in patients with either of the hand-sewn reservoirs using an ileal or ileocolic segment. CONCLUSIONS: Although the W-stapled ileal reservoir is safe and allows reservoir formation quickly, the inconsistencies of the results discourage its use in the particular configuration described. Failure of the reservoir to distend could be a function of reservoir design, areas of ischemia in the reservoir, or reaction to staple material. Absorbable staples on the GIA instrument may work satisfactorily for formation of an ileocolic reservoir for continent cutaneous diversion. However, the W-configured orthotopic reservoir as constructed using absorbable staples in this study is inferior to a hand-sewn ileal or ileocolic neobladder.

Aged↗
PubMed1995

Laparoscopic appendectomy: three-puncture technique with suspension of the appendix in nineteen cases.

Nineteen laparoscopic appendectomies by the same general surgeon are reported, using three trocar sites and suspending the appendix along the right lower quadrant trocar. This approach provides a fourth access site to the appendix without an additional port. Once the position of the appendix is stabilized, the two available ports are used to dissect around the base of the mesoappendix and place a silk ligature with extracorporeal ligating technique. All 19 procedures were completed by endoscopic means and without the use of endoscopic stapling devices, even when the mesoappendix was markedly swollen and edematous. The technique is presented here as an alterative method when performing laparoscopic appendectomy.

Appendectomy↗
PubMed2005

A comparison of burst pressure between buttressed versus non-buttressed staple-lines in an animal model.

BACKGROUND: The consequences of a staple-line leak or disruption can be devastating particularly in the bariatric surgery population. This study was designed to assess if gastrointestinal staple-lines buttressed with bovine pericardium could tolerate greater intraluminal pressures compared with non-reinforced staple-lines. METHODS: A laparoscopic linear cutting staple device was used to create divided staple-lines across the small intestine in a porcine model and the stomach in a rabbit model. 21 staple-lines were created with buttressing strips of bovine pericardium, and another 21 staple-lines were created without any reinforcement. All staple-lines were subjected to a constant rate increase in intraluminal pressure via intraluminal infusion of a dye solution. At the first sign of seam leak or failure, the burst pressure was recorded. RESULTS: In 19 of the 21 studies, the staple-lines buttressed with bovine pericardium sustained higher mean burst pressures than the conventional non-buttressed staple-lines. For the porcine intestinal segments, the mean intraluminal pressure at failure was 125 +/- 24 mmHg for buttressed staple-lines versus 58.4 +/- 28 mm Hg for conventional staple-lines (P <0.0001). For rabbit stomach segments, the mean intraluminal pressure at failure was also significantly higher for the buttressed segments (115 +/- 24 vs 75.6 +/- 23, P <0.0137). Most buttressed segments failed away from the staple-line, while the non-buttressed segments failed at the staple-line. CONCLUSIONS: Gastrointestinal staple-lines buttressed with bovine pericardium are able to maintain seam integrity at significantly higher intraluminal pressures when compared to non-buttressed GI staple-lines in animal models.

Anastomosis, Roux-en-Y↗
PubMed1993

Laparoscopic-assisted vaginal hysterectomy: report on 32 initial cases.

Techniques for laparoscopic-assisted vaginal hysterectomy are being developed in the hope that these new techniques will improve patient care. This article reviews the initial experience of the author with the Endo-GIA stapling device in performing laparoscopic-assisted vaginal hysterectomy. The results showed this technique to be an attractive alternative to the traditional abdominal approach.

Female↗
PubMed1993

Power staple fixation in trapeziometacarpal arthrodesis.

Twenty-seven trapeziometacarpal arthrodeses were performed in 26 patients for basilar thumb joint arthritis utilizing power staple fixation. Short arm thumb spica cast immobilization was maintained for an average of 8 weeks, followed by part-time splintage for 6-12 weeks. Twenty patients were available for evaluation an average of 19 months after the operation. All of the patients were satisfied with the procedure. Thirteen had complete relief of pain, four had mild pain, and three had moderate pain after surgery. The two nonunions that occurred were in patients that refused postoperative casting and both had complete pain relief. There were no fixation-related complications in the remaining 18 patients that were casted postoperatively, and all developed a solid fusion. Power staple fixation in trapeziometacarpal arthrodesis has a 90% union rate with no long-term fixation related complications.

Arthrodesis↗