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PubMedDate not supplied

Does stapled functional end-to-end anastomosis affect recurrence of Crohn's disease after ileocolonic resection?

BACKGROUND/AIMS: Crohn's disease is characterized by a high incidence of perianastomotic recurrence after ileocolonic resection. The influence of anastomotic configuration on the incidence of reoperation was evaluated in patients undergoing resection for Crohn's disease. METHODOLOGY: 106 patients affected by ileocolonic Crohn's disease were divided in two groups: group I with a hand-sewn end-to-side or side-to-side isoperistaltic anastomosis (30 patients) and group II with functional end-to-end anastomosis made with linear staplers (76 patients). RESULTS: The morbidity was 4.7%: 3 complications and a postoperative death occurred in group I and two complications occurred in group II. There were 5 recurrences (16.7%) in the hand-sewn group and 2 recurrences (2.6%) in the stapled group, with a recurrence rate of 3.54 and 0.92, respectively. CONCLUSIONS: Our non-randomized study suggests a better trend toward the functional stapled technique, in terms of recurrence rate. These observations need further investigation with randomized controlled trials, to compare the two different anastomotic procedures.

Adult↗
PubMedDate not supplied

Long-term results of leg length discrepancy treated with temporary epiphyseal stapling in children with juvenile chronic arthritis.

OBJECTIVE: The aim of the present study was to evaluate retrospectively the long-term efficacy of temporary stapling of the knee epiphyses over four decades of use in children with JCA. METHODS: Medical data of the patients with temporary epiphyseodesis due to leg length discrepancy (LLD) were studied. Seventeen knees in 17 patients were found with sufficient follow-up data for evaluation. Patient documents and radiographs of these patients were evaluated. RESULTS: The mean age at the time of the operation was 11 years (range: 6-15) in 3 males and 14 females. The preoperative mean LLD was 21 mm (SD 8) and at staple removal 4 mm (SD 10). The difference was -17 mm (95% CI: -10 to -23). Statistically the result remained the same during the follow-up. Two reversible complications were documented among the 17 stapled knees. In five (29%) cases the correction was affected by re-occurrence of LLD quickly after removal of the staples. CONCLUSION: In this study with 17 patients and a wide range of follow-up times we found that the good correction of LLD achieved by stapling is usually permanent.

Adolescent↗
PubMed1994

A comparison of stapled vs handsewn anastomosis in anterior resection for carcinoma rectum.

The merits of stapled versus hand sewn anastomosis were evaluated in a prospective randomized study of 60 patients undergoing resection for rectal cancer. The analysed factors included the time required for construction of anastomosis, post operative complications, local recurrence, disease free state and survival. Hand sewn anastomosis was performed in two layers with 3/0 silk in 30 cases and the stapled anastomosis with EEA staplers in 30 cases. The anastomosis time averaged 24 minutes in the suture group and 16 minutes in the stapling group. Five post-operative complications occurred in each group. Six patients of the hand sewn group developed local recurrence as a first sign of treatment failure compared to four patients in the stapled group. The average time of study was 41 months. No significant difference was found in the overall survival pattern of the two groups.

Adenocarcinoma↗
PubMed1995

Retained staples as a cause of mechanical small-bowel obstruction.

The use of mechanical stapling devices in endoscopic surgery has become widespread and commonplace. Although problems have been identified with these, to our knowledge no description has been made of retained, free intraperitoneal staples causing significant morbidity. We describe the case of a patient who underwent laparoscopically assisted vaginal hysterectomy. Four weeks postoperatively she developed a mechanical small-bowel obstruction which was caused by a free intraperitoneal staple creating an obstructing band. The obstruction was relieved laparoscopically. We believe that while retained free intraperitoneal staples are generally of no clinical consequence, surgeons should be aware that the potential exists for significant morbidity.

Adult↗
PubMed1995

Initial experience of using GRAFTAC absorbable staples to attach split skin grafts.

The GRAFTAC skin stapler with absorbable tacs has been used to attach split-skin grafts in 28 patients, under a variety of clinical situations, and the outcomes studied. This knowledge has been reviewed in the light of our existing experience with the more familiar metal staple. Details of the patients and their conditions are presented, with two illustrative case histories, including one where both Graftac and metal staples were used. The relative costs were analysed and an attempt made to compare the cost-effectiveness of tacs and staples. A rationale for use of the more expensive GRAFTAC stapler is presented.

Adolescent↗
PubMed1997

Intraoperatively controlled small-incision forehead and brow lift.

Placement of screws at the posterior aspect of the incision sites and the gradual placement and removal of staples behind the screws allow for a controlled and titrated elevation of the forehead and brows. This technique does require the patient's acceptance of the temporary placement of screws and staples into the scalp, which in my experience has not been a problem. By seating the patient upright on the operating table, the surgeon can intraoperatively make a direct evaluation and adjustments (removal or addition of staples). This approach leads to a more controlled elevation of the forehead and brows and the potential of a more symmetrical and satisfactory result.

Anesthesia, Local↗
PubMed2003

Staple line bleeding following laparoscopic splenectomy: intraoperative prevention and postoperative management with splenic artery embolization.

Laparoscopic splenectomy (LS) has become the procedure of choice for a variety of hematologic disorders and non-traumatic splenic pathology. Perioperative hemorrhage remains one of the most feared complications. We report 2 cases of postoperative splenic artery hemorrhage following vascular division using 2.5-mm Endo-GIA stapling cartridges. In this paper we identify and discuss important technical aspects of obtaining hilar vascular control during LS and report the first use of postoperative splenic artery embolization to control staple line bleeding following LS.

Embolization, Therapeutic↗
PubMed1996

Modification of the stapled functional end-to-end anastomosis for ileostomy closure.

The use of stapling devices simplifies ileostomy closure; however, the original functional end-to-end anastomotic technique creates intersecting staple lines, generally causing disruption of the anastomosis at the intersections. Therefore, we modified the stapling technique to prevent the two staple lines from crossing. After the everted ileostomy spout is turned back, a stapled side-to-side anastomosis is made. Everting traction sutures are then placed around the ileostomy orifice prior to closure with a linear stapler, thus ensuring that this staple line does not cross the V-shaped staple line of the intestinal anastomosis. This modified technique was employed in the treatment of 20 patients, none of whom developed any signs of anastomotic leakage or intestinal obstruction.

Anastomosis, Surgical↗
PubMed2002

Randomized clinical trial of stapled haemorrhoidopexy versus conventional diathermy haemorrhoidectomy.

BACKGROUND: The aim of this study was to compare the results of stapled haemorrhoidopexy (commonly called stapled haemorrhoidectomy) with those of conventional diathermy haemorrhoidectomy. METHODS: Fifty-five patients with symptomatic third- and fourth-degree haemorrhoids were randomized to either stapled haemorrhoidopexy (n = 27) or conventional diathermy haemorrhoid ectomy (n = 28). Operating time, postoperative pain, time to return to work, postoperative complications and effectiveness of haemorrhoidal symptom control were recorded. The mean follow-up was 15.9 months in the stapled haemorrhoidopexy group and 15.2 months in the conventional haemorrhoidectomy group. RESULTS: Mean pain intensity was significantly less in the stapled group (P = 0.001). There were no significant differences in the total number of complications, the length of absence from work or control of symptoms. Seven patients in the stapled group re-presented with prolapse compared with none in the conventional haemorrhoidectomy group (P = 0.004). This difference was also observed in the subset of patients with fourth-degree haemorrhoids (P = 0.003). CONCLUSION: The stapled operation was significantly less painful than conventional haemorrhoidectomy. However, the rate of recurrent prolapse was higher after stapled haemorrhoidopexy than after conventional diathermy haemorrhoidectomy.

Diathermy↗
PubMedDate not supplied

Fragment fixation with a bone graft and dynamic staples for osteochondritis dissecans of the humeral capitellum.

To attain bony union of the fragment in osteochondritis dissecans of the humeral capitellum, fragment fixation was performed with a bone graft and dynamic staples in 4 patients. The staples were inserted not from the articular surface but from the lateral aspect of the capitellum. All patients achieved bony union without complication, and 3 of them returned to playing competitive baseball. At final follow-up after surgery (mean, 7.5 years [range, 2.1-11 years]), 3 patients were able to throw a ball without pain and the remaining patient felt elbow dullness after he played recreational-level baseball as a pitcher. These results suggest that the procedure of fragment fixation with a bone graft and dynamic staples can provide satisfactory results for osteochondritis dissecans of the humeral capitellum with a large osteochondral fragment.

Adolescent↗
PubMed2002

Percutaneous femoral arteriotomy repair -- initial experience with a novel staple closure device.

The Vascular Closure System (EVS ) is the first device to utilize a staple mechanism to close percutaneous femoral arteriotomies following catheter-based procedures. To assess safety and efficacy, the EVS was used to close 89 consecutive femoral arteriotomies. Closure success was defined as complete cessation of bleeding within five minutes of staple delivery. The overall closure success rate was 92.1% (n = 82). Mean time to complete hemostasis was 2.47 1.42 minutes. No complication (re-bleeding, pseudoaneurysm, transfusion, arteriovenous fistula, infection or decrease in distal pulses) occurred at 24-hour and 7-day follow-up. We conclude that staple-based technology provides a safe and useful method for mechanical closure of percutaneous femoral arteriotomies.

Angioplasty↗
PubMed1996

[Stapling in thoracic surgery].

The author presents a brief historical account on the development of automatic sewing equipment. Based on his own 30-year experience he mentions its possible use in thoracic surgery and discusses its justification in thoracic surgery with regard to various aspects.

Humans↗
PubMed1996

Rectovaginal fistula following low circular stapled anastomosis in women with rectal cancer.

Low anastomosis using a circular stapling instrument has become standard for performing a colorectal reconstruction following resection of a rectal cancer. Often these anastomoses are performed deep in the pelvis using a circular stapling instrument without clear visualization of the anastomotic site. In the female patient, unless an adequate stump of rectum is left above the circular staple line, there is danger that the side wall of the posterior aspect of the vagina can be included in the tissue rings (donuts) that are resected by the circular stapling instrument. This leaves the patient at high risk for late development of a rectovaginal fistula by vaginal mucosa being incorporated into the rectal wall. Maintenance of an adequate mucosa beyond the linear staple linen and a vaginal examination prior to firing the circular stapler will prevent this problem. A patient is presented and the technical details for a safe low-low colorectal anastomosis are reviewed.

Aged↗
PubMed1995

Risk of residual rectal mucosa after proctocolectomy and ileal pouch-anal reconstruction with the double-stapling technique. Postoperative endoscopic follow-up study.

PURPOSE: This study was designed to assess the risk of retained rectal mucosa after proctocolectomy and ileal pouch-anal anastomosis with the double-stapling technique. METHODS: A total of 113 patients underwent proctocolectomy with an ileal pouch-anal reconstruction. In 57 patients the anastomosis between pouch and proximal anal canal was performed using the double-stapling technique. In 26 patients the procedure was carried out without a protecting ileostomy. Of the remaining 31 patients with a proximal ileostomy, 15 underwent endoscopy six weeks postoperatively. Circular biopsies were taken just distal from the pouch-anal anastomosis. RESULTS: Histologic examination revealed rectal mucosa in at least one biopsy in 7 of 15 patients. At follow-up (mean 18 months) no (distal) pouchitis was clinically noticed. In one patient with familial polyposis, a few polyps, distal of the anastomosis, had to be endoscopically removed. CONCLUSIONS: Double-stapled ileal pouch-anal anastomosis has a considerable risk of residual rectal mucosa, because of combined linear transection and circular stapling with bilateral dog-ear formation of rectal mucosa. Residual rectal mucosa did not seem to influence clinical results at follow-up.

Adenomatous Polyposis Coli↗
PubMed2003

Endoscopic management of Zenker diverticulum: the staple-assisted approach.

Hypopharyngeal (Zenker) diverticulum is a physiologic obstruction of the esophageal entroitus due, at least in part, to reflux irritation. Endoscopic techniques have largely replaced the traditional treatment, comprising external excision and myotomy. In this article, the classic Dohlman technique is compared with the newer endoscopic staple-assisted esophagodiverticulostomy, which provides an endoscopic approach to Zenker diverticulum-associated dysphasia. This technique can be practiced with a simulator, requires little experience, has a good safety record, and has acceptable results.

Esophagoscopy↗
PubMed1997

Trapeziometacarpal joint arthrodesis for osteoarthritis. Results of power staple fixation.

Fifty-two cases of trapeziometacarpal joint osteoarthritis were treated with arthrodesis using small staple fixation. Eighty-five per cent of the patients were free of pain, with normal thumb. Opposition to the fourth finger tip was always possible and opposition to the little finger tip was observed in 94% of cases. Four patients (7.6%) developed a non-union but only two complained of pain. Arthrodesis with power staple fixation minimizes bone resection and postoperative immobilization (mean 28 days) because of the good stability following this procedure.

Adult↗