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PubMed1995

Stapled intestinal anastomosis in neonates and infants: use of the endoscopic intestinal stapler.

Stapled anastomoses of the gastrointestinal tract, commonplace in adults and older children, are rarely performed in newborns because of the size of the instruments. The development of smaller stapling devices for laparoscopic and thoracoscopic procedures presented an opportunity to evaluate the efficacy of such anastomoses in neonates and infants. Over an 11-month period, seven newborn or young infants underwent stapled functional end-to-end small or large intestinal anastomoses using the Endo-GIA 30. The male:female ratio was 3:4, and the mean age was 72d (range, 1 to 134 days). The mean weight at the time of the stapled anastomosis was 3.7 kg (range, 1.88 to 6.6 kg). The clinical setting requiring the intestinal anastomoses included ileostomy closure after perforated necrotizing enterocolitis (3), intestinal atresia (1), distal ileal volvulus (1), left colon mesenteric cyst (1), and biliary atresia (1). There were no deaths or anastomotic leaks. Nasogastric decompression was discontinued at a mean of 6 days (range, 3 to 11 days), and oral feedings were begun at a mean of 7.0 days (range, 4 to 12 days). The patients were discharged from the hospital 7 to 117 days after the operation (mean, 33 days). The endoscopic stapling instrument is safe and effective in performing small and large intestinal anastomoses in newborns and young infants.

Age Factors↗
PubMed1996

Should lung volume reduction for emphysema be unilateral or bilateral?

Both unilateral and bilateral lung volume reduction procedures are being advocated for treatment of severe, generalized emphysema. We analyzed the results of 166 consecutive patients who underwent unilateral (n = 87) or bilateral (n = 79) thoracoscopic stapled lung volume reductions to help define the role for these procedures. There was no statistically significant difference in the operative mortality (3.5% vs 2.5%), mean length of stay (11.4 +/- 1 vs 10.9 +/- 1 days), or morbidity for the unilateral and bilateral groups, respectively (p not significant for all variables). Oxygen dependence was eliminated in 18 (36%) of 50 patients who had unilateral procedures and 30 (68%) of 44 of those who had bilateral procedures (p < 0.01). Prednisone was eliminated for 38 (54%) of 51 unilateral-procedure patients, compared with 30 (85%) of 35 bilateral-procedure patients (p = 0.02). Overall, bilateral procedures produced a mean improvement in the forced expiratory volume in 1 second (FEV1) of 57%, compared with 31% for unilateral reduction procedures (p < 0.01). Our bilateral staple procedure produced a 72.8% mean increase in the FEV1 for patients who had upper lobe emphysema. Especially compromised patients (age > or = 75, with preoperative room air Po2 < or = 50 mm Hg or FEV1 < or = 500 ml) had the same morbidity and operative mortality with unilateral or bilateral procedures, but they had a higher 1-year mortality (17% vs 5%), primarily because of respiratory failure after the unilateral operation (p < .001). Although unilateral staple lung volume reduction may produce an excellent result in a given patient, the bilateral procedure appears to be the procedure of choice, because it provides better overall results at no increased morbidity or mortality compared with the unilateral procedure. The results of bilateral staple lung volume reduction by thoracoscopy appear to be comparable to those of median sternotomy.

Aged↗
PubMed2002

Intraoperative techniques to prevent air leaks.

Persistent air leaks prolong chest tube duration and hospital stay after lung surgery. Air leaks also may lead to life-threatening empyemas. Preventing postoperative air leaks and BPFs is the best treatment for air-leak complications. Meticulous closure of parenchymal, pleural, and bronchial defects is the mainstay of air-leak control. The reinforcement of parenchymal suture and staple lines, pleural apposition, and well-vascularized tissue-flap coverage of bronchial suture and staple lines further reduce the incidence of prolonged air leaks and BPFs.

Animals↗
PubMed1999

Comparison of the endoscopic stapling technique with more established procedures for pharyngeal pouches: results and patient satisfaction survey.

Pharyngeal pouch surgery by the external approach has been shown to be effective but has a relatively high complication rate. We compared the outcome of 17 patients who had cricopharyngeal myotomy alone or combined with excision/inversion/suspension, simple pouch excision and Dohlman's procedure with 17 patients who had the relatively new Endo GIA-30 endoscopic stapling technique. Results were obtained retrospectively by postal questionnaire and medical records. We conclude that endoscopic stapling shortens the return to normal diet and in-patient stay. These patients also experience better swallowing and are generally more satisfied with the procedure. We have accepted endoscopic stapling as the method of choice for the treatment of pharyngeal pouches.

Aged↗
PubMed2003

Biomechanical superiority of plate fixation for proximal tibial osteotomy.

Proximal tibial osteotomies require secure and durable fixation to allow early range of motion; however, biomechanical data comparing commonly used fixation methods are lacking. The current study was done to quantify the dynamic biomechanical performance of blade staple fixation and plate fixation of simulated proximal tibial osteotomies. A 15 degrees proximal tibial osteotomy was done on each of 18 synthetic adult composite tibias. Blade staples were used as the means of fixation in nine tibias; plate fixation was used in the remaining nine tibias. The specimens were stressed cyclically in sinusoidal loading whose peak compression and tension loads imitate those measured during normal gait. Device performance was quantified by measuring displacement at the osteotomy site and the number of cycles to failure. Plate fixation had a greater fatigue life than staples (eight plates surviving past 200,000 cycles versus one blade staple) and showed a trend toward less displacement (0.69 mm versus 0.97 mm). Plate fixation of proximal tibial osteotomies offers better fixation and dynamic mechanical performance than blade staples.

Adult↗
PubMed2000

Comparison of titanium vascular closure staples with suture repair of the thoracic aorta in swine.

OBJECTIVE: Devices that reduce technical difficulty and anastigmatic time when repairing large vessels such as the thoracic aorta would be beneficial. The aim of this study was to determine if titanium vascular closure staples (3 mm) could be safely and quickly applied in the repair of large vessels such as the thoracic aorta. DESIGN: Through a left thoracotomy in 10 female swine (110 to 130 lb), an interposition graft (14 to 16 mm textile) was placed into the aorta distal to the left subclavian artery. Animals were randomized at the time of repair to either running sutures (n = 5; 6-0 polypropylene) or vascular closure staples (n = 5; 3 mm). The anastomosis was evaluated after 2 months with aortograms, and the aorta was harvested to evaluate healing. RESULTS: The clamp times (mean +/- SD) were 30.8 +/- 8.2 min for suture repair and 24.8 +/- 5.1 min for vascular closure staple repair (p = 0.2). Anastomosis times were 20. 0 +/- 6.2 min for the suture group and 16.4 +/- 6.4 min for the vascular closure staple group (p = 0.4). Arch aortograms at 2 months revealed no significant difference in luminal narrowing between the two groups. Gross and microscopic examination revealed no thrombosis, well-healed wounds with a continuous intimal layer, and no differences in intimal thickness or inflammation between the two groups. CONCLUSION: Vascular closure staples were equivalent to sutures in terms of durability, graft patency, and wound healing at 2 months. Vascular closure staples may offer the trauma surgeon a quick and easy alternative when repairing large vessels such as the thoracic aorta.

Anastomosis, Surgical↗
PubMed2001

Gastric schwannoma found incidentally 19 years after a horizontal gastroplasty for morbid obesity.

This report represents the first known case of a gastric schwannoma in a patient subsequent to a gastric stapling and partitioning procedure for morbid obesity. The submucosal tumor found in the collapsed distal portion of the stomach was merely an incidental finding and it appeared that all of the patient's ongoing symptomatology (nausea and vomiting after meals) was a reflection of the chronic obstruction that was present at the gastric partitioning staple-line. No correlation between gastric stapling and partitioning and the development of gastric schwannoma is known or is suggested in this report.

Diagnosis, Differential↗
PubMedDate not supplied

Evaluation of a skin stapler for belt-loop gastropexy in dogs.

A new method for attachment of a belt-loop gastropexy using disposable, stainless steel skin staples was compared with a traditional hand-sewn belt-loop gastropexy technique in 24 fresh dog cadavers. Mean gastropexy times were 212 seconds for the stapled technique and 435 seconds for the hand-sewn technique. The stapled belt-loop gastropexy was significantly faster than the hand-sewn technique (P less than 0.001). There was no statistically significant difference in the mean maximum tensile strength between the two attachment methods. This study provides a basis for clinical evaluation of the stapled belt-loop gastropexy technique in dogs.

Abdominal Muscles↗
PubMed2003

[A device to prevent an air-leakage after a thoracoscopic surgery for spontaneous pneumothorax].

PURPOSE: In a thoracoscopic surgery for the patient with spontaneous pneumothorax, an air-leakage from the staple-line is one of the most troublesome complications. Recently we have been using a polyglycolic acid (PGA) sleeve for staple-line reinforcement. The purpose of this study was to investigate an efficacy of staple-line reinforcement in the patients who underwent thoracoscopic lung resection using an automatic stapler. OBJECTS: Last 4 years, 55 patients with primary spontaneous pneumothorax underwent thoracoscopic surgery using an automatic stapler. PGA sleeve was used in 19 patients as PGA group, fibrin glue was applied to the staple-line in 6 patients as fibrin group and no staple-line reinforcement was applied in 30 patients as no-reinforce group. We investigated the efficacy of staple-line reinforcement according to the results after surgery in these 3 groups. RESULTS: Average drainage time in PGA group, fibrin group and no-reinforce group were 2.1, 2.2 and 2.8 days, respectively. In PGA group, the drainage time after surgery tended to be short term. The relapse of pneumothorax after surgery developed in 2 patients in PGA group (10.5%) and 8 patients in non-reinforce group (26.7%). In PGA group, the relapse after surgery tended to be low rate. CONCLUSIONS: Bioabsorbable PGA sleeve could be an useful device for a staple-line reinforcement in the patients who underwent lung resection using automatic stapler.

Adolescent↗
PubMed1994

A simple stapling technique for prosthetic repair of massive incisional hernias.

This article introduces a simpler, faster, and safer method of performing the Stoppa procedure with an articulating stapler. It also encourages use of preperitoneal repair instead of the often unsuccessful onlay mesh repair. The latter repair involves placing the mesh over the abdominal aponeurotic layer and can result in a high incidence of infection, seroma accumulation, and chronic fibrous cyst formation. In the preperitoneal repair technique, the same force that created the hernia--the intraabdominal hydrostatic pressure--keeps the mesh tightly in place and prevents recurrence of the hernia. The authors base their recommendation of the stapling technique on the experience of 54 large incisional hernias successfully repaired by preperitoneal insertion of a large sheet of Marlex mesh (Stoppa's procedure). In 29 of the 54 patients, the mesh was fixed in place with hand suturing. In the other 25, articulating staplers attached the mesh. The authors have found the stapling technique to be both simpler to accomplish and safer for the patient.

Abdomen↗
PubMed2006

Gastrointestinal complications of bariatric surgery: diagnosis and therapy.

Severe or morbid obesity, with body mass indexes exceeding 35 to 40, are often refractory to all therapies other than surgery. The increasing number of patients undergoing bariatric surgery will result in increasing numbers of patients with gastrointestinal complications. The types of complications vary with type of surgery, whether restrictive, malabsorptive, or both, depending on what anatomical and physiologic changes occur postoperatively. One complication of bariatric surgery (gallstones) is due to weight loss after surgery, not the surgery itself. Based on previous meta-analyses, most of the top 10 complications from bariatric surgery are gastrointestinal: dumping, vitamin/mineral deficiencies, vomiting (and nausea), staple line failure, infection, stenosis (and bowel obstruction), ulceration, bleeding, splenic injury, and perioperative death. Two other gastrointestinal complications of bariatric surgery are indirect consequences of the surgery: bacterial overgrowth and diarrhea. Awareness of the types and frequency of gastrointestinal complications of bariatric surgery allows for timely diagnosis and appropriate therapy. As new surgical, and even endoscopic, procedures to treat obesity are developed, new gastrointestinal complications will need to be recognized.

Avitaminosis↗
PubMed1996

Comparison of handsewn with stapled loop ileostomy closures.

PURPOSE: The aim of this study was to determine if a stapled side-to-side closure of an ileostomy results in decreased length of hospital stay compared with a handsewn closure. METHODS: From March 1993 to August 1994, patients who had previously undergone total proctocolectomy with pelvic pouch formation and loop ileostomy were studied. At the time of ileostomy closure, patients were randomized to have their stoma closed by a handsewn technique or stapled closure. Data were prospectively gathered. RESULTS: During 17 months, 61 consecutive patients (38 male, 23 female) with a mean age of 37.8 (range, 16-69) years had their ileostomy closed and were entered into this study. There were 31 patients in the stapled group and 30 in the handsewn group. Mean operative time was 55 (range, 32-97) minutes in the stapled group and 67 (range, 42-128) minutes in the handsewn group (P = 0.01 Wilcoxon's test). Average length of stay was three (range, 2-5) days in the stapled group and 2.5 (range, 1-19) days in the handsewn group. One patient from the stapled group and two patients from the handsewn group were readmitted because of small-bowel obstruction. One patient from the stapled group underwent additional surgery for a leaking enterotomy with no defect in staple closure. Two patients from the handsewn group underwent additional surgery for small-bowel obstruction. There was no significant difference in day of first stool or day of solid diet for the two groups. CONCLUSION: Handsewn and stapled closures of loop ileostomy are not significantly different with respect to day of first stool, day until solid diet, or discharge day. Complications were similar in the two groups. Stapled closure is significantly quicker than handsewn closure.

Adolescent↗
PubMed2002

Staple-line ulcer in the ileal reservoir following restorative proctocolectomy.

PURPOSE: Following restorative proctocolectomy, seven cases with staple line ulcer around the pouch anal anastomosis and/or staple line in the ileal pouch were experienced. Their clinical, endoscopical characteristics were analyzed. METHODS: The patients noted anal bleeding following restorative proctocolectomy were examined with colonofiberscopy and histological study was conducted. RESULTS: Staple line ulcer was seens in seven cases (2.3%, 7/304). The onset was immediate or within 2 months postoperatively in 5 cases. Bleeding occurred in all the patients and lower abdominal pain, anal pain, increased bowel movements and anal fissure were seen frequently. Ulcers were linear along the staple line and there were no cases complicated by simultaneous pouchitis. Most of the patients responded to treatments with metronidazol, 5-ASA, and topical or oral steroids, although one patient required ligation of bleeding ulcer and two complicated perianal excoriation required ileostomy. CONCLUSION: Staple line ulcer should be recognized as different complication to pouchitis.

Adenomatous Polyposis Coli↗
PubMed2006

Rectovaginal fistula after STARR procedure complicated by haematoma of the posterior vaginal wall: report of a case.

We report the case of a patient treated with the stapled transanal rectal resection (STARR) procedure for obstructed defecation, who developed an early postoperative haematoma of the posterior vaginal wall and, after 30 days, a rectovaginal fistula (RVF), even though the intervention had been performed according to the standardized technique. After clinical examination and three-dimensional anal endosonography, we carried out a successful surgical correction with double vaginal and rectal flaps with repair of the rectovaginal septum and without faecal diversion. The STARR procedure, even if performed according to a rigorous application of the methodological standards, may be followed by a RVF possibly due to a blood collection leading to ischaemia of the vaginal wall.

Female↗
PubMed1995

Early clinical results with the uncut Roux reconstruction after gastrectomy: limitations of the stapling technique.

BACKGROUND: The aim of this study was to review our early clinical experience with the uncut Roux gastrectomy, a modified Billroth II gastrojejunostomy in which four rows of staples occlude the afferent jejunal lumen, while biliary and pancreatic secretions are diverted distally through a jejunojejunostomy. METHODS: Between September 1991 and April 1993, 9 women and 5 men underwent uncut Roux gastrectomy for gastric adenocarcinoma (5), postvagotomy or idiopathic gastroparesis (7), Roux stasis syndrome (1) or anastomotic ulceration with gastric outlet obstruction (1). Subsequently, patients were seen or contacted by phone within the 6 months prior to March 1994. RESULTS: Eight of the 14 patients (57%) had excellent results with stable weight and no nausea, vomiting, heartburn, abdominal pain, or postprandial symptoms. One patient continued to have early satiety and vomiting but maintained stable weight for 19 months postoperatively. Five patients (36%) had poor results with alkaline reflux gastritis or esophagitis. All 5 had documented staple line dehiscence. Four of them were reoperated on and converted to a standard Roux operation with relief of symptoms. CONCLUSIONS: The uncut Roux operation prevents the Roux stasis syndrome, but the current technique has an unacceptably high incidence of dehiscence of the staple lines with subsequent reflux gastritis or esophagitis.

Adult↗
PubMed2000

Management of the bronchial stump in pulmonary resections: a review of 533 consecutive recent bronchial closures.

OBJECTIVE: The method used to achieve bronchial closure, especially the relative merits of sutured versus stapled closure, remains an important topic among thoracic surgeons who seek the best way to prevent postoperative bronchopleural fistula (BPF) formation. METHODS: Bronchial closure in 533 consecutive stumps in pulmonary resection from 1995 to 1997 at the National Cancer Center Hospital, Tokyo, was reviewed in terms of the incidence of troubles related to mechanical stapling (stapling failure) and to BPF formation. Fifty stumps (9%) were closed by manual suturing and 483 (91%) by mechanical stapling. For stapling, endostaplers were used for 313 stumps (65%), and other types of conventional staplers for 170 stumps (35%). RESULTS: There were 18 stapling failures (a 3.7% overall incidence, 4.8% for endostaplers, 1.8% for other types of staplers). However, of these 18 patients only one developed BPF after surgery. Seven BPFs developed postoperatively among the 533 closures (overall incidence, 1.3%): two after manual suturing (4%) and five after stapling (1%), and this difference was not statistically significant. Of seven patients with BPF, four died of BPF-related complications. CONCLUSIONS: Although bronchial closure by stapling was accompanied by failure, its incidence was acceptable and was not directly associated with the development of BPF postoperatively, as long as properly repaired. Newly developed endostaplers had similar incidence of stapling failure and BPF formation compared with other types of conventional staplers. These results suggest endostaplers can be used safely for various types of bronchial closure. The advantage of such devices could be the least chance of pollution of the operative field, simultaneous performance of stapling and division by one motion, and subsequently great saving of time.

Bronchi↗
PubMed1997

Comparison of different methods used to inhibit physeal growth in a rabbit model.

A rabbit model was used to compare the rate, efficacy, and histologic appearance of physeal growth inhibition effected by Phemister epiphysiodesis, epiphyseal stapling, and percutaneous epiphysiodesis. Each technique led to an effective physeal closure, although the Phemister and staple methods produced more rapid deceleration of growth. A slower rate of physeal closure was seen after percutaneous epiphysiodesis, because this technique produced a gap in the bone that initially filled with fibrous tissue before forming bridges of trabecular bone leading to closure of the growth plate. Elevation of the periosteum alone produced an initial growth stimulation followed by early physiologic physeal closure. The amount of physis to ablate when doing a percutaneous epiphysiodesis is controversial. These results suggest that a percutaneous technique with limited physeal ablation, as used in the current study, effects slower rate of growth inhibition than that by the Phemister and staple techniques. A percutaneous technique that ablates a larger portion of the physis may be desirable to obtain more rapid growth inhibition.

Animals↗
PubMed2001

Stapled laparoscopic gastropexy for paraesophageal hernia.

A minimally invasive correction of symptomatic paraesophageal hernia in high-risk elderly patients is described with an emphasis on a new method of laparoscopic gastropexy that is simple, reliable, and can be performed rapidly.

Digestive System Surgical Procedures↗