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PubMed2005

Esophagogastrectomy: the influence of stapled versus hand-sewn anastomosis on outcome.

Successful anastomosis is essential for favorable esophagogastrectomy outcomes. Before July 2002, almost all esophagogastric anastomoses at our institution were hand-sewn. We then began using linear stapled anastomotic techniques. This review compares patient outcomes with both techniques. From July 2001 to June 2004, 280 consecutive esophagogastrectomy patients (235 men and 45 women) were reviewed (median age, 65 years). The anastomosis was intrathoracic in 206 patients (74%) and cervical in 74 (26%). Anastomoses were hand-sewn in 205 patients (73%) and linear stapled in 75 (27%). Stapled anastomoses were intrathoracic in 33 patients (16%) and cervical in 42 (57%). Anastomotic leaks occurred in 30 patients (11%); 26 (12.7%) in the hand-sewn and 4 (5.3%) in the linear stapled group (P = .008). Leaks were asymptomatic in 17 patients (57%). Dilatation was required in 70 hand-sewn anastomoses (34%) and in 11 stapled (14.6%) (P = .001). Hand-sewn anastomoses were more likely to leak and require dilatation; odds ratios and 95% confidence intervals were 5.35 (1.67-19.27) and 3.58 (1.66-8.34), respectively. A linear stapled anastomosis is safe and associated with both a significantly lower leak rate and the need for dilatation compared with hand-sewn anastomosis. This nonrandomized series suggests that linear stapled anastomosis is the preferred technique regardless of anastomotic location.

Adult↗
PubMed1999

Prospective randomized study of stapled versus unstapled mesh in a laparoscopic preperitoneal inguinal hernia repair.

BACKGROUND: In 1975, researchers introduced the use of a large unsutured polyester mesh prosthesis placed in the preperitoneal space for inguinal hernia repair. Different stapling devices have been used to secure this mesh, and the most common complication of the procedure is nerve damage secondary to the staples. The necessity of stapling has never been demonstrated. We designed a prospective randomized study of the need for stapling in laparoscopic extraperitoneal repair of inguinal hernias with 1-year and 3-year followup. STUDY DESIGN: Inclusion criteria of the study were men older than 18 years and first-time inguinal hernia repair. Patients with recurrence and previous abdominal operations were excluded to avoid confounding variables. Each patient's hernia was assigned a consecutive random number chosen by computer, with each number corresponding to an assigned group. The first group had stapled mesh and the second had unstapled mesh. RESULTS: Data were collected over a 15-month period, with each procedure having a mean followup time of 8 months. A total of 100 procedures was performed in 92 patients. The two groups of patients were well matched for age and the type of hernia repaired. There were no recurrences in either group and no complications or deaths. CONCLUSIONS: The initial 12-month followup showed no significant differences in recurrence or complication rates between the stapled and unstapled groups. Both groups returned to work within an average of 4 days. A net savings of $120 was realized for each hernia repair performed without stapled mesh. In addition, stapling presents an inherent risk of nerve damage.

Costs and Cost Analysis↗
PubMed1994

Laparoscopic gastrojejunostomy: a case presentation.

Laparoscopic gastrojejunostomy is demonstrated as an alternative to open gastric bypass procedures. We performed the operative procedure safely and with reasonable anesthesia time, using stapling devices. It is hoped that further patient benefit will be obtained from this laparoscopic procedure in the future.

Adenocarcinoma↗
PubMedDate not supplied

Stapled aortic anastomoses: a minimally invasive, feasible alternative to videoscopic aortic suturing?

Widespread applications of totally laparoscopic aortic reconstructions have been limited by the long cross-clamp time required to suture the aortic anastomosis despite improvement in instrumentation. The authors' hypothesis was that a "one-step anastomosis concept" using an intraluminal stapler would allow shorter cross-clamp time but similar patency and imperviousness as videoscopic suturing techniques. An intraluminal stapler (Endopath-ILS, Ethicon) with a modified anvil was used to perform videoscopic-assisted thoracic aorta-to-iliac artery bypass with a 21 mm by 8 mm polytetrafluoroethylene (PTFE) graft in 22 sheep through a minimally invasive approach using a 5 cm thoracotomy. The graft-to-iliac artery anastomoses were hand sutured through a flank incision. Twelve sheep were used to establish the technique and 10 subsequent animals constituted the study group. Aortic cross-clamp time, imperviousness, and need for additional sutures were recorded and compared to previously reported data using videoscopic suturing in pigs. Patency was assessed by comparing lower limb arterial pressures. Macroscopic and microscopic examinations of the anastomoses were performed at different time-points within the first 3 months. Videoscopic-assisted stapled anastomoses were also performed on atherosclerotic aortas of 3 human cadavers. Stapled anastomoses between the thoracic aorta and PTFE graft were completed in 8 of 10 animals. Two animals were euthanized after stapler failure and anastomotic bleeding. Sutures to strengthen the anastomosis had to be used in 4 cases. Mean aortic cross-clamp time in 8 successful cases was 4.3 +/-2.9 minutes (range 2-11 minutes) and was significantly shorter than clamp time of videoscopic suturing technique (48.7 +/-9.4 minutes, p < 0.0001). Imperviousness was good or excellent in 4 animals and fair in 4 animals. All anastomoses were patent at the end of the procedure. Examination of the anastomosis of the 2 failed interventions showed medial aortic tear surrounding the anastomosis in 1 case and misfired staples in the other. No graft occlusion was noted during follow-up ranging from 0 to 12 weeks. At the time of harvest, no bleeding was noted after epinephrine and volume infusion to increase mean arterial pressure to 200 mm Hg for 15 minutes. Macroscopic examination of the anastomoses revealed adequate healing with circumferential stapling of the prosthesis to the aortic wall and no stenosis or thrombus except in 1 false aneurysm (1/7, 14%). Surface electron microscopy showed cells coverage of the anastomosis surface. When applied on human cadaver thoracic and abdominal aorta with atherosclerotic changes, clamping times of less than 5 minutes were achieved. However, imperviousness tested with saline was poor. An automatic stapling device allows performance of a graft-to-aorta anastomosis through a minimally invasive approach with shorter clamping time than a videoscopic suturing technique. However, the current technique of aortic stapling is unreliable and further improvements are needed.

Anastomosis, Surgical↗
PubMed1998

Anterior resection following posterior transsacral stapling and transection of the anal canal for low-lying rectal cancer in males.

In anterior resection with anastomosis using the double-staple technique for low-lying rectal cancer in male patients, the approach to the anal canal with a stapling instrument via the abdominal area is limited by the narrow pelvis. The stapling and transection of the anal canal via the posterior transsacral approach prior to performing an anterior resection thus enables the lower rectum and anal canal to be visualized, so that the anal canal can be accurately stapled and transected even in male patients with a narrow pelvis.

Anal Canal↗
PubMed2002

Arthroscopic repair of osteochondritis dissecans of the femoral condyles with metal staple fixation: a report of 28 cases.

In a retrospective clinical study we evaluated the outcome of arthroscopic repair of osteochondritis dissecans (OCD) of the femoral condyles with metal stable fixation. Twenty-eight knees of 26 patients (mean age 20 years) with OCD of the knee were treated by fixation of the fragments with Hoffmann's dynamic metal staples arthroscopically and by additional arthrotomy in 7 knees. At follow-up (mean 4 years, 1-7) patients were interviewed for any residual symptoms and underwent a routine clinical and radiographic examination. The clinical results were based on the grading scale of Lysholm. The 17 knees which did not require further surgery showed 13 instances of complete healing, 3 of partial healing, and 1 of nonhealing. The 11 knees which had reoperations showed 2 instances of complete healing, 5 of partial healing, and 4 nonhealing. There was no significant difference between early or late surgery, and results were not related significantly to site of the lesion, handling of the fragment and the crater, percutaneous drilling, or type of fragmentation. Clinical grading of 13 knees was as excellent, 11 good, and 4 fair. Broken stables were observed in 9 knees, and they were removed from 5 knees. Complete healing was thus achieved in one-half and partial healing in one-third of cases. The metal staples used here fit for use in the arthroscopic fixation of the OCD of the knee, although the staples had a marked liability to break.

Adolescent↗
PubMed2004

Management of recurrent anastomotic stricture and iatrogenic stenosis by circular stapler.

Anastomotic stricture is an increasingly common clinical finding. It is thought to arise because of ischemia, disruption, or leakage at an anastomosis site. Its management can be difficult and strictures often are resistant to standard dilation therapy. Major corrective surgery is possible; however, it is technically challenging and not without risk. We have used a circular stapler to excise colorectal strictures, introducing the anvil of the stapler via a proximal stoma or colotomy, drawing the anvil through the stricture with a snare via a colonoscope and affixing it to the body of a circular staple gun and excising the stricture. We have with found this to be an effective treatment in appropriately selected patients.

Aged↗
PubMed2005

Arthroscopic fixation of avulsion of the posterior cruciate ligament from femoral insertion.

Femoral avulsion of the posterior cruciate ligament (PCL) is not common, especially in adults. We present a case and an arthroscopic repair technique using 4 transfemoral tunnels; 2 anterior tunnels for fixation of the anterior bundle of the PCL and 2 posterior for the posterior bundle. Our case was that of a femoral avulsion of the PCL associated with tibial avulsion of the anterior cruciate ligament and femoral avulsion of the medial collateral ligament of the left knee in an adult. We repaired the tibial avulsion of anterior cruciate ligament using an arthroscopic transtibial suture technique and the femoral avulsion of the medial collateral ligament by using staple fixation.

Accidents, Traffic↗
PubMed2001

Prospective randomized multicentre trial comparing stapled with open haemorrhoidectomy.

BACKGROUND: The aim of this study was to compare the results of conventional open haemorrhoidectomy as currently practised in Italy (group 1) with stapled haemorrhoidectomy using a 33-mm circular stapling device (group 2). METHODS: One hundred patients with symptomatic third- and fourth-degree haemorrhoids were enrolled by five hospitals. Patients were allocated to the two groups according to a centralized randomization scheme featuring five permutated blocks of 20. Preoperative clinical examination and anorectal manometry demonstrated no features of anal incontinence. Patients had a clinical and manometric re-evaluation after operation and were asked to complete a clinical diary. After a median of 16 (range 8-19) months patients were administered a standardized questionnaire by telephone. RESULTS: Postoperative bleeding requiring haemostatic procedures occurred in three patients in each group. Patients in group 1 complained of moderate pain for a median of 5.3 (range 0-19) days compared with 3.1 (range 0-10) days in group 2 (P = 0.01), while severe pain was present for 2.3 (range 0-24) days in group 1 but only for 1 (range 0-14) day in group 2 (P = 0.03). The median hospital stay was 2 days in group 1 compared with 1 day in group 2 (P = 0.01). In the early days after operation, patients in group 2 had greater difficulty in maintaining normal continence to liquid stools (P = 0.01), but after 30 days the continence score was better in group 2 (P = 0.04). CONCLUSION: Stapled haemorrhoidectomy is as effective as conventional haemorrhoidectomy. Reduced postoperative pain, shorter hospital stay and a trend toward earlier return to work suggest short-term advantages for the stapled technique.

Adult↗
PubMed1996

Video assisted thoracoscopic staple resection of a giant bulla.

Video assisted thoracoscopic surgery (VATS) for spontaneous pneumothorax has been well described. However, there are few reports on the use of this technique on giant bullae. We report a 49 year old man with a symptomatic giant bulla who underwent a successful thoracoscopic staple resection. His chest drains were removed on the second postoperative day and he was discharged on the third postoperative day with virtually no discomfort. We conclude that thoracoscopic staple resection of a giant bulla is feasible technically and is an attractive alternative to the conventional open technique.

Electrocoagulation↗
PubMed2004

Securing central venous catheters: a comparison of sutures with staples.

OBJECTIVES: Central venous access permits rapid drug delivery to the central circulation during cardiopulmonary resuscitation. Central venous catheters must be secured in place to prevent accidental removal and sutures are often used for this purpose. Staples may offer advantages over sutures by reducing the time needed to secure the central venous catheter and reducing exposure to contaminated sharps. The purpose of this study was to assess a staple anchoring device (Arrow, Reading, USA) and compare it with sutures for securing central venous catheters. METHODS: Prospective, randomised trial of 20 patients requiring insertion of a central venous catheter during elective surgery. RESULTS: Mean (SD) times were significantly shorter in the staples group than in the sutures group (staples 10.1 (3.5) seconds; sutures 50.5 (9.6) seconds; p<0.0001). However, 3 of 10 central venous catheters in the staples group were accidentally pulled out within the first three days. CONCLUSIONS: The use of staples significantly reduces the time to secure a central venous catheter. However, staples failed to secure the central venous catheters adequately and therefore cannot be recommended instead of sutures.

Catheterization, Central Venous↗
PubMed1996

Surgicel reinforced resection lines in left-sided hepatectomy with linear stapling device. An experimental study on pigs.

Fourteen pigs underwent left-sided hepatectomy. The resection was performed with a linear stapling device and the pigs were randomised to either Surgicel reinforced resection lines or not. The median time required for resection was 25 min (range 17-30) in the Surgicel reinforced group compared to 30 min (range 21-41) in the stapled group. This difference was, however, not statistically significant (p = 0.053). The postoperative haemoglobin value was lower in the stapled group compared to the Surgicel reinforced group 69 g/l (range 42-85) versus 82 g/l (range 78-90) (p = 0.018). The estimated blood losses by weighing the compresses were 287 ml (range 166-379) for the stapled group and 204 ml (range 152-264) for the Surgicel reinforced group (p = 0.053). The median number of additional haemostatic sutures in the Surgicel reinforced group was 7 (range 3-11) and in the stapled group 10 (range 5-15) (p = 0.038). The haemoglobin value was similar in the two groups 1 week postoperatively; 100 g/l (range 87-104) and 102 g/l (range 95-114), p = 0.27, in the stapled group and the Surgicel reinforced group, respectively. In the stapled group reinforced with the Surgicel there was one postoperative death. In the solely stapled group there was no postoperative death (p = 0.5). Four out of six pigs in the Surgicel group had massive adhesions to the resection lines. One of these six pigs was sacrificed postoperatively as it was ill and had small bowel obstruction secondary to Surgicel induced adhesions. On the other hand, no adhesions were seen in the solely stapled pigs (p = 0.09). At this point, we can not recommend the use of Surgicel to reinforce resection lines at stapled liver resection in the clinical situation, because of the high frequency of adhesions this material creates.

Animals↗
PubMed1995

Ileal pouch anal function after endoanal mucosectomy and handsewn ileoanal anastomosis compared with stapled anastomosis without mucosectomy.

OBJECTIVE: To compare manovolumetric results and functional outcome after restorative proctocolectomy with either mucosal proctectomy and handsewn pouch-anal anastomosis or stapling. DESIGN: Prospective randomised study. SETTING: University hospital, Sweden. SUBJECTS: 80 Consecutive patients undergoing restorative proctocolectomy. INTERVENTIONS: 37 patients were randomised to have mucosectomy and a handsewn anastomosis and 43 patients to have a stapled anastomosis. MAIN OUTCOME MEASURES: Comparisons of anal sphincter function and clinical outcome in terms of continence and overall functional score between the two groups of patients. RESULTS: There was persistent reduction in anal resting tone at one year amounting to 29% in the handsewn group and and to 21% in the stapled group (p < 0.001 compared with preoperative in both groups). Daytime continence was similar, but patients with stapled anastomoses experienced less soiling during sleep, especially in the early postoperative period (5/43, 12% compared with 15/33, 45% at one month, p < 0.001). The arbitrary overall functional score was, however, similar in both groups. CONCLUSION: Handsewn and stapled ileal pouch-anal anastomoses result in similar postoperative anal sphincter impairment and overall clinical outcome.

Adolescent↗
PubMed1997

A modified stapling technique for esophagojejunostomy after total or proximal gastrectomy.

BACKGROUND: Stapling devices reduce the leakage rate of digestive tract anastomoses, but they increase the risk of strictures. We investigated a newly modified technique of end-to-end anastomosis stapling in esophagojejunostomy after total or proximal gastrectomy. STUDY DESIGN: A modified stapling technique (using a stapled anastomosis between esophageal mucosal and intact jejunal layers, with hand-sewn seromuscular sutures between the esophagus and jejunum) was used in 21 patients (modified group), while a conventionally stapled anastomosis was performed in 17 patients (conventional group). The incidence and severity of dysphagia and the size of the anastomosis as determined from x ray films were compared in the two groups. RESULTS: The modified technique provided significantly better results for dysphagia severity than the conventional method (p = 0.0025). Most of the patients in the modified group had mild dysphagia, and most patients in the conventional group complained of moderate or severe dysphagia. In the modified group, the inner diameter of the anastomosis was 12.1 +/- 2.5 mm, significantly larger than that in the conventional group (10.0 +/- 1.8 mm; p = 0.009). CONCLUSIONS: The use of our modified stapling technique can minimize the risk of anastomotic stricture and the feeling of dysphagia after esophagojejunostomy.

Aged↗
PubMed1994

Double-stapled vs. handsewn ileal pouch-anal anastomosis in patients with chronic ulcerative colitis.

UNLABELLED: Proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the treatment of choice for most patients with chronic ulcerative colitis. Whether or not a double-stapled technique, which should preserve the anal transition zone and avoid prolonged and dilation, facilitates superior fecal continence compared with conventional mucosal resection and handsewn anastomosis is unknown. PURPOSE: The aim of this study was to compare functional results after double-stapled and handsewn IPAA. METHODS: Twenty-seven consecutive patients (13 females, 14 males; mean age, 37 years) who had proctocolectomy and double-stapled IPAA (J) for chronic ulcerative colitis were identified. Each was matched by sex, age, and surgeon to a control who had undergone a conventional handsewn anastomosis. Functional results at six months after ileostomy closure were compared. RESULTS: Median stool frequency in each group was seven. The prevalence of pouchitis was 22 percent in both groups. One pouch failure occurred in each group. The percentage of patients from the double-stapled group with daytime spotting was similar to that of the handsewn group (18 percent vs. 26 percent, P > 0.5). Nighttime soiling rates were similar as well (41 percent vs. 48 percent, P > 0.5). CONCLUSIONS: Double-stapled IPAA appears to convey no early functional advantage over handsewn IPAA for chronic ulcerative colitis.

Adolescent↗
PubMed2002

A new bioabsorbable sleeve for staple-line reinforcement: report of a clinical experience.

PURPOSE: The most frequent and troublesome complication after resection of an emphysematous lung is persistent air leakage. This report describes our recent experience of using sleeves made of polyglycolic acid to reinforce staple-lines to reduce air leaks after resection of emphysematous lung. METHODS: We used bioabsorbable sleeves made of polyglycolic acid (PGA) for staple-line reinforcement during lung resections in 25 patients with emphysema. RESULTS: Immediately after stapling, no air leaks were detected in 20 patients (80%), although prolonged air leaks lasting for more than 7 days were observed in three patients (12.5%). CONCLUSION: PGA sleeves do not constitute a foreign body that stays in the host lung, and they require no rinsing at the time of clinical use. Therefore, the PGA sleeve could be a promising new material instead of non-absorbable materials and xenomaterials for staple-line reinforcement.

Absorbable Implants↗