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PubMed2005

[Use of vascular stapling device in liver resections].

BACKGROUND: Among several liver resection techniques, the use of stapler in the portal pedicles is an interesting option. AIM: To describe the technique of liver resection using a vascular stapling device. PATIENTS AND METHODS: A total of eight patients underwent hepatic resections with stapling techniques. The authors have used intrahepatic approach glissonian pedicles with the application of a vascular stapler device in all cases. Liver parenchyma and hepatic veins were transected as usual. RESULTS: There were no deaths. No complications directly attributable to stapler ligations of portal pedicles were observed. CONCLUSION: Stapling techniques can be helpful in hepatic resection procedures. The vascular stapler may significantly reduce glissonian pedicle section time.

Adult↗
PubMed2005

Outcome of hemiepiphyseal stapling for late-onset tibia vara.

BACKGROUND: The results of hemiepiphysiodesis for the treatment of late-onset tibia vara have been reported to be favorable, but the technique requires careful timing and an accurate estimation of skeletal age. Hemiepiphyseal stapling does not require a careful estimation of skeletal age, and it has been reported to yield good results with low morbidity. However, we are not aware of any study evaluating the intermediate-term radiographic results or complications of this procedure. METHODS: Twenty-six patients with thirty-three extremities with late-onset tibia vara were treated with proximal tibial hemiepiphyseal stapling. Fourteen extremities had substantial concomitant distal femoral varus and also had hemiepiphyseal stapling of the distal part of the femur. Eighteen patients (twenty-three involved extremities) had juvenileonset tibia vara and eight patients (ten involved extremities) had adolescent-onset tibia vara. The mean age at the time of stapling was 11.8 years. The mean duration of follow-up was 3.8 years. We reviewed standardized standing radiographs to determine the mechanical axis deviation, the medial proximal tibial angle, the lateral distal femoral angle, and the zone of the knee through which the mechanical axis passed. RESULTS: The mean mechanical axis deviation improved from 58 mm (range, 27 to 157 mm) preoperatively to 22 mm (range, -33 to 117 mm) at the time of the last follow-up, and the mean medial proximal tibial angle improved from 77 degrees (range, 50 degrees to 85 degrees ) to 85 degrees (range, 48 degrees to 95 degrees ). In the fourteen lower extremities in which distal femoral hemiepiphyseal stapling was performed, the mean lateral distal femoral angle improved from 96 degrees (range, 92 degrees to 100 degrees ) to 86 degrees (range, 79 degrees to 97 degrees ). At the time of the final follow-up, seven extremities were considered to be in moderate varus; four, in mild varus; twenty, in normal alignment; and two, in valgus. No differences in radiographic outcome were noted between the juvenile and adolescent forms of tibia vara. Only one of the four extremities with severe preoperative varus was corrected to normal alignment; the remaining three were left with moderate varus. CONCLUSIONS: Hemiepiphyseal stapling of the lateral aspect of the proximal tibial physis and, as needed, the lateral aspect of the distal femoral physis is safe and effective in children with late-onset tibia vara if the physes are sufficiently open and the varus deformity is mild to moderate. Hemiepiphyseal stapling is particularly effective in patients who are ten years of age or younger. LEVEL OF EVIDENCE: Therapeutic Level IV.

Adolescent↗
PubMed2003

Prospective randomized study of bacteraemia in diathermy and stapled haemorrhoidectomy.

BACKGROUND: The incidence and consequences of bacteraemia associated with diathermy and stapled haemorrhoidectomy have not been studied previously. METHODS: Two hundred and five healthy patients randomized to stapled haemorrhoidectomy or diathermy haemorrhoidectomy had perioperative blood cultures taken. The clinical sequelae of bacteraemia and complications of surgery were assessed prospectively. RESULTS: Six patients were excluded for protocol violations. Eleven (11 per cent) of 101 patients with stapled and five (5 per cent) of 98 who had diathermy haemorrhoidectomy had positive blood cultures for organisms after haemorrhoidectomy, predominantly anaerobes commonly found within the bacterial flora of the anorectum (P = 0.19). Transient postoperative pyrexia in several patients did not correlate with detected bacteraemia and settled spontaneously without treatment. There were no serious complications from either operative technique, and no clinical consequences from proven bacteraemia. CONCLUSION: Transient bacteraemia may complicate surgical haemorrhoidectomy but has no serious clinical consequences for healthy adults.

Adult↗
PubMed1995

Stapled stricturoplasty for Crohn's disease. A new technique.

PURPOSE: Stricturoplasty was originally used to treat multiple fibrotic strictures of tuberculosis. As the pendulum of treatment of Crohn's disease swung toward conservatism and bowel preservation, stricturoplasty was performed in Crohn's disease. Stricturoplasty can be used when there is limited, well-localized disease and should be avoided in the presence of grossly inflamed or infected material. We describe a new technique of stricturoplasty. METHODS: Typically stricturoplasty is performed in a manner similar to a Heineke-Mikulicz pyloroplasty. A stapled stricturoplasty technique has been previously described, but in actuality these are more similar to a bypass procedure. Our technique uses a stapled, open technique similar to the triangulating method of bowel anastomosis. This was performed in one patient to correct six strictures. RESULTS: Our patient did well postoperatively and developed no significant complications. He has no evidence of recurrent strictures. CONCLUSION: We describe a stapled stricturoplasty technique that is truly a stricturoplasty because the bowel lumen is increased; it is similar to the triangulating method of end-to-end stapled bowel anastomosis. It is safe, efficient, and effective. Additionally, it allows radiographic location of the stricturoplasty site, thus allowing determination of effectiveness of the procedure as well as recurrence.

Constriction, Pathologic↗
PubMed2002

Use of a mattress suture to eliminate dog ears in double-stapled and triple-stapled anastomoses.

Double-stapling techniques for restorative rectal resection have been effective in minimizing local contamination compared with open circular stapling techniques. Inclusion of the transverse staple line closure of the distal rectal stump in the circular stapled anastomosis may minimize the risk of suture line recurrence. A technique for formation of such an anastomosis is described that avoids use of a distal purse string.

Aged↗
PubMed2002

Objective comparison of stapled anopexy and open hemorrhoidectomy: a randomized, controlled trial.

PURPOSE: This trial compares stapled anopexy with open hemorrhoidectomy in patients with prolapsing (Grade 3) hemorrhoids. Particular attention was paid to changes in anorectal physiology, nature of tissue resected, quality-of-life assessments, and cost implications of the treatments studied. METHODS: An initial pilot study was followed by a randomized, controlled trial in a District General Hospital in the United Kingdom. All patients had Grade 3 hemorrhoids. Nineteen patients were studied in the pilot study, with 99 patients in the randomized, controlled trial. All patients in the pilot study and 59 in the randomized, controlled trial underwent stapled anopexy. Thirty patients in the randomized, controlled trial underwent open hemorrhoidectomy. Of the 59 patients in the stapled group, 32 were treated with the Ethicon PPH stapling device, and 27 received stapling with a reusable Autosuture stapling device. The following variables were measured: demographic details, quality of life (Medical Outcomes Study Short Form 36 and directed questions), anorectal manometry, and histology. RESULTS: There was no difference in the case mix within or between the groups. The stapled anopexy groups showed a significant reduction in operative time (P < 0.001) and blood loss (P < 0.001) compared with open hemorrhoidectomy. Open hemorrhoidectomy resulted in significantly greater usage of protective pads postoperatively (P < 0.001) and longer rehabilitation (P < 0.006). CONCLUSIONS: Stapled anopexy is an effective alternative treatment for prolapsing hemorrhoids that allows reduced operative time and shorter rehabilitation. It does not appear to affect continence or overall quality of life.

Adult↗
PubMed2003

A randomized, controlled trial of diathermy hemorrhoidectomy vs. stapled hemorrhoidectomy in an intended day-care setting with longer-term follow-up.

PURPOSE: Hemorrhoidectomy is the most effective long-term treatment for hemorrhoids. Although it is possible to perform hemorrhoidectomy as a day case with a high degree of patient satisfaction, patients take an average of 14 days off work after surgery. Stapled hemorrhoidectomy is believed to be less painful than conventional hemorrhoidectomy and should allow an earlier return to work. The aim of this study was to compare both the immediate and the long-term results of stapled hemorrhoidectomy with diathermy hemorrhoidectomy in patients with prolapsing internal hemorrhoids in an intended day-care setting. METHODS: Thirty-one patients were randomly assigned to undergo diathermy hemorrhoidectomy (n = 16) or stapled hemorrhoidectomy performed with a purpose-designed endoluminal stapling device, PPH01T (n = 15). All operations were planned as day or short-stay cases. All patients received lactulose, commenced preoperatively, together with postoperative topical glyceryl trinitrate and oral metronidazole. Patients were assessed by structured interview to assess their symptoms before and after surgery, with an intended follow-up of six months. All patients completed a 10-cm visual analog pain scale daily for the first ten days after surgery. RESULTS: The total pain score (sum of all pain scores) was significantly higher in the diathermy group (50 (range, 9.8-79.9) vs. 19.6 (range, 1.3-89.5), P = 0.03). Patients took a median of 14 (range, 3-21) days off work after diathermy hemorrhoidectomy compared with 10 (range, 3-38) days for the patients undergoing stapled hemorrhoidectomy (P = 0.15). At long-term follow-up, three patients (all in the stapled group) developed new symptoms of fecal urgency and anal pain, and three patients required further surgery to remove symptomatic external hemorrhoids after stapled hemorrhoidectomy. CONCLUSIONS: Although stapled hemorrhoidectomy is less painful in the short term, this does not lead to a significantly earlier return to work, and some patients develop new symptoms at long-term follow-up.

Adult↗
PubMedDate not supplied

Development and evaluation of an in vivo mouse model for studying myocutaneous flap microcirculation and viability before and after suturing or stapling.

A model was developed in albino hairless mice to study microcirculation and viability of dorsal distally based myocutaneous flaps. The efficacy of this model was tested in 120 mice by evaluating the effects of excessive crimping and tension attributed to Proximate or Signet staples or to simple or mattress nylon sutures. Microhemodynamics were assessed using computer-assisted intravital videomicroscopic and electro-optical methods. Volumetric rates of blood flow were calculated within terminal arterioles from measurements of internal diameter and mean centerline cellular velocity. The viability was determined on day 5 by measuring the areas of necrosis (mm2) along the cut edges of these flaps. In 80 mice, flaps were elevated and examined at 0 h and then again at 24 or 48 h. There were 40 mice in each of these disturbed groups. In a third group of 40 mice, flaps were raised at 0 h without videomicroscopic examination at 0, 24, or 48 h (undisturbed group). All flaps were stapled or sutured to the original donor site with one of the four methods of closure. The results of this study indicate that sutures produce the highest incidence of necrosis at 5 days when compared to staples in the undisturbed groups of mice. However, no significant differences in necrosis were observed when flaps were disturbed at 48 h despite videomicroscopic evidence of depressed blood flow along their cut edges. In contrast, results at 24 h were equivocal and statistically not significant. These data suggest that the phenomenon of delay and/or flap recirculation following removal and reapproximation of sutures or staples drastically improves perfusion and viability of disturbed flaps.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2002

Influence of stapler haemorrhoidectomy on anorectal function and on patients' acceptance.

PRINCIPLES: Symptomatic haemorrhoids surgery has been shown to be the most successful and definite therapy. Recently a new method using a transanally inserted circular stapler has been presented for treatment of symptomatic prolapsing haemorrhoids. This prospective study investigated the influence of the stapling procedure on the anorectal function and patients' acceptance. METHODS: Eighteen consecutive patients (10 males, 8 females) mean age 44.7 years (range 18- 66) with symptomatic second (n = 3), third (n = 14), and fourth degree (n = 1) haemorrhoids were included. All patients underwent the day before and 8 weeks after the operation a standardised anal manometry using a water perfused system. Mean resting (MRAP) and mean maximal squeeze anal pressures (MSAP) were recorded. Volumes of initial rectal sensation (VIRS), constant rectal sensation (VCRS), and maximal tolerable volume (MTV) of a rectal balloon were assessed. Anorectal symptoms (bleeding, pain, faecal incontinence) were assessed in a standardised fashion preoperatively and 1, 8, and 12 weeks postoperatively. RESULTS: The stapling procedure led to no manometric or symptomatic change in anal sphincter function. Pre- and postoperative MRAP (91.7 mm Hg, SD 23.59 / 83.8 mm Hg, SD 14.53, p = 0.053), MSAP (162.6 mm Hg SD 78.68 / 173.9 mm Hg, SD 69.93, p = 0.162), VIRS (55.8 ml, SD 26.12 / 51.7 ml, SD 28.90, p = 0.410), VCRS (109.4 ml SD 41.67/ 96.4 ml, SD 38.44, p = 0.181), and MTV (204.7 ml SD 47.65/ 173.3 ml, SD 43.22, p = 0.053) were similar. No symptoms of rectal pain or faecal incontinence were registered during follow up. Patients' acceptance and satisfaction for the operation were high. CONCLUSIONS: Stapling haemorrhoidectomy is a safe procedure which does not alter anorectal functions. Patients' acceptance and satisfaction are high.

Adolescent↗
PubMed2005

Glycolide copolymer staple-line reinforcement reduces staple site bleeding during laparoscopic gastric bypass: a prospective randomized trial.

HYPOTHESIS: The use of staple-line reinforcement sleeves during laparoscopic gastric bypass reduces staple-line bleeding, which may translate into a reduction in the rate of gastrointestinal hemorrhage. DESIGN: Prospective randomized trial. SETTING: University hospital. PATIENTS AND INTERVENTIONS: Thirty-four patients undergoing laparoscopic gastric bypass were randomly assigned to receive either no reinforcement (control group, n = 17) or reinforcement of the staple line with glycolic copolymer sleeves (treatment group, n = 17). MAIN OUTCOME MEASURES: Demographic data, the number of stapler loads used, the number of staple-line bleeding sites, the amount of blood loss, the length of time required to obtain hemostasis of the staple lines, operative time, intraoperative and postoperative complications, and serial hemoglobin levels. RESULTS: The mean number of stapler loads used was similar between groups. The mean number of staple-line bleeding sites was significantly fewer in the treatment group for division of gastric tissue (0.4 vs 2.5 bleeding sites), jejunal tissue (0.1 vs 0.6 bleeding site), and mesenteric tissue (0 vs 0.8 bleeding site). The mean blood loss was lower in the treatment group (84 vs 129 mL). Staple misfire occurred in 1 (0.7%) of 143 stapler loads used in the treatment group compared with 0 (0%) of 138 stapler loads used in the control group. The time to obtain staple-line hemostasis was shorter in the treatment group (1.2 vs 10.1 minutes). The total operative time was similar between groups. There was no mortality or postoperative leaks. One patient in the control group had postoperative gastrointestinal hemorrhage requiring blood transfusion and reoperation. There was no significant difference in the mean hemoglobin level between groups on the first postoperative day. CONCLUSIONS: The use of glycolide copolymer staple-line reinforcement sleeves in patients undergoing laparoscopic gastric bypass is safe and significantly reduces staple-line bleeding sites and may reduce the incidence of gastrointestinal hemorrhage.

Adult↗
PubMed2006

Experience of 3711 stapled haemorrhoidectomy operations.

BACKGROUND: Stapled haemorrhoidectomy has been routinely performed in the Department of Colorectal Surgery, Singapore General Hospital since 1999. METHODS: A retrospective review was undertaken of all patients who underwent stapled haemorrhoidectomy between October 1999 and May 2004. The outcomes studied were patient profiles, priority of operation, indications for surgery, length of operation, postoperative complications and recurrences. RESULTS: A total of 3711 patients (51.1 per cent women) had the surgery. The median patient age was 50 (range 18-88) years. The main indications were bleeding (80.7 per cent), haemorrhoidal prolapse (59.6 per cent) and thrombosis (3.9 per cent). The median duration of operation was 15 (range 5-45) min. Minor complications occurred in 12.3 per cent of patients: acute retention of urine (4.9 per cent), bleeding (4.3 per cent), significant postoperative pain requiring admission (1.6 per cent), anorectal stricture (1.4 per cent), perianal haematoma (0.05 per cent) and significant residual skin tags (0.05 per cent). One patient developed a perianal abscess after stapled haemorrhoidectomy. Anastomotic dehiscence occurred in three patients (0.08 per cent). Twelve (0.3 per cent) patients had a recurrence at a median of 16 (range 5-45) months. CONCLUSION: Considerable experience of stapled haemorrhoidectomy confirms it as a safe and effective procedure.

Adolescent↗
PubMed1993

Treatment of intra-articular fractures with shape memory compression staples.

The management of intra-articular fractures remains difficult. Shape memory compression staples fulfil nearly all the special treatment requirements of intra-articular fractures. Early bone union and 93.5 per cent satisfactory function were achieved in a series of 121 cases. Stable fixation, 'early' movement and continuous compressive force produced by the staple are the main factors contributing to good results.

Adolescent↗
PubMed2004

En bloc stapling of renal hilum during laparoscopic nephrectomy and nephroureterectomy.

OBJECTIVES: To evaluate the safety and advisability of en bloc mass stapling of the renal pedicle during difficult laparoscopic nephrectomy to avoid conversion to an open procedure. METHODS: A retrospective chart review was performed of 433 consecutive patients undergoing laparoscopic simple or radical nephrectomy or laparoscopic nephroureterectomy between August 1998 and July 2003 by two surgeons. In all cases of en bloc hilar ligation, a stapler was deployed across the renal hilum without individual dissection of the renal artery and vein. RESULTS: The overall incidence of en bloc ligation was 6.0% (26 of 433 patients). The reasons for en bloc ligation were a difficult hilar dissection and/or the appearance of the renal hilum in 21 cases and urgent ligation secondary to bleeding in 5 cases. No correlation was found between surgeon experience and the frequency of en bloc ligation. No immediate or short-term complications related to this method of hilar division were observed with a mean follow-up of 26 months. CONCLUSIONS: In this study, no cases of arteriovenous fistula development occurred after en bloc stapling of the renal pedicle. Long-term follow-up is needed, because arteriovenous fistula development may be a late complication of nephrectomy. Although we do not advocate the generalized use of en bloc division of the renal pedicle, early data suggest that en bloc stapling can be performed to avoid conversion to an open procedure with no related short-term complications.

Arteriovenous Fistula↗
PubMedDate not supplied

Tarsal joint fusion using memory compression staples--a study of 10 cases.

A prospective clinical study was undertaken to assess the effectiveness of Nickel-Titanium Memory compression staples for fusion of the intertarsal joints. Ten patients underwent procedures for fusion of various hindfoot and midfoot joints with the memory staples. The patients were evaluated regarding period of immobilization in cast and time to radiographic joint fusion. Arthrodesis was achieved in all patients. The average time to fusion was 7.8 weeks, with an average period of immobilization of 6.6 weeks. The early experience with the use of these staples in hindfoot and midfoot joint surgery is encouraging. We did not encounter any technical problems, and there is a suggestion that these implants may reduce the time to fusion.

Arthrodesis↗
PubMed1995

Surgery for pediatric ulcerative colitis.

Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) has become the "gold standard" operation for treatment of ulcerative colitis refractory to medical therapy. The J-pouch is the simplest to construct, produces the fewest complications, and is used most commonly. Long-term function with the IPAA is good in approximately 90% of cases, and patient satisfaction is high. Controversial aspects of the operation include 1) whether mucosectomy and hand-sewn IPAA is better than anal transition zone preservation and stapled anastomosis, 2) whether a temporary diverting ileostomy should be used, 3) the role for IPAA in the treatment of indeterminate colitis, 4) the etiology and the most effective treatment for pouchitis, and 5) the best method for salvaging the failed pelvic pouch.

Anal Canal↗
PubMed1998

Staple augmentation to treat a humeral nonunion after failed Seidel locked nailing.

Seidel locked nailing has been successfully used to treat a humeral shaft fracture or nonunion. However, if union fails despite this treatment, the next approach to try has not been well defined. We, therefore, developed a technique using a staple to enforce the local stability without removing the failed nail. The technique was very simple, and the outcome was always satisfactory.

Adult↗
PubMed1995

Potential complications of vascular stapling in thoracoscopic pulmonary resection.

In a series of 57 patients undergoing thoracoscopic pulmonary lobectomy, 2 required expeditious conversion to open thoracotomy when a stapling device (Endo-GIA 30 V3; Autosuture, Ascot, UK) used on the main right lower pulmonary artery in 1 case and on the left superior pulmonary vein in the other cut but failed to staple the vessel involved. In both instances the vessel was successfully controlled while a thoracotomy was performed and the involved vessel was oversewn. Both patients made an uncomplicated postoperative recovery. As the number of thoracoscopic pulmonary resections increases, it is likely that similar episodes will occur in the future. These cases strongly emphasize the fact that patients undergoing this procedure should do so in a center specializing in thoracic surgery where there is the necessary surgical expertise and equipment to deal with such potentially life-threatening vascular complications.

Adenocarcinoma, Bronchiolo-Alveolar↗