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At least 883 records · Page 49Linked to original sources
PubMed2001

Revisional bariatric surgery--safe and effective.

BACKGROUND: Revision operations have traditionally been considered difficult and associated with a high complication and long-term failure rate. This paper demonstrates that revision and/or conversions to Roux-en-Y gastric bypass are generally safe as well as effective in long-term weight maintenance and control of co-morbidities. METHODS: A retrospective study from January 1989 through August 1999 was done involving 141 patients who had had various gastroplasty (118), gastric banding (6), jejunoileal bypass (3), or loop (2) and Roux-en-Y gastric bypass (RYGBP) procedures (12), with either technical failures or poor long-term maintained weight loss. RESULTS: The demographics were: mean pre-operative weight at original surgery 264 lbs (120 kg); postop weight at a mean elapsed time since surgery of 5 years, 4 months: 188 lbs (85 kg), or a mean excess weight loss of 59%. The mean BMI dropped from a pre-op 45 to a post-op 31. There were 7 complications which required emergency surgery (5%), which included 4 leaks, 2 subphrenic abscesses, and 1 wound dehiscence. Other complications included 4 hernias, 3 staple-line failures, 1 transient renal failure, and 3 incidences of peptic ulcer disease requiring surgery, giving a total major complication rate of 13% in 17 patients, with no deaths. An earlier experience of this author comparing conversion RYGBP vs revision gastroplasty found better morbidity rates and weight loss with those converted to RYGBP. CONCLUSION: Converting failed gastric limiting and other bariatric procedures to RYGBP was safe and effective. Technical approaches to each problem type encountered are presented.

Gastric Bypass↗
PubMed2006

Stapled diverticulectomy and myotomy for symptomatic Zenker's diverticulum.

BACKGROUND: Few surgeons have extensive experience with the operative management of Zenker's diverticulum (ZD). METHODS: Retrospective review of stapled diverticulectomy and cricopharyngeal myotomy (SDM) for ZD. All procedures were performed by midlevel surgery residents supervised by single board-certified surgeon. A drain was not used, and patients were liberally advanced to a regular diet postoperatively. RESULTS: Three patients with ZD underwent this procedure during a 6-year period. The mean age of the patients was 81 years, and all had multiple comorbidities. Time to discharge was less than 48 hours in 2 patients and 5 days in 1 patient who developed new atrial fibrillation. There were no deaths or clinical leaks. At a mean follow-up of 33 (range 6-62) months, 1 patient died of an unrelated cause, and the other 2 are free of esophageal-related symptoms. CONCLUSIONS: SDM for ZD is a safe and effective operation that is easily taught to surgical residents.

Aged, 80 and over↗
PubMed1997

Reversal of tubal sterilization using laparoscopically placed titanium staples: preliminary experience.

We tested the feasibility of performing outpatient laparoscopic surgery to reverse tubal sterilization using titanium staples to reapproximate the oviducts. A total of 14 women underwent the procedure which involved excision of the tubal eschar, stenting of the severed remnants, and circumferential stapling of the muscularis and serosa. Reapproximation was possible in all cases, with a measured tubal length post-anastomosis of 4.5 +/- 0.5 cm (range 3.0-7.0 cm). The length of operating time was 2.8 +/- 0.2 h (range 2.2-3.8 h), and all patients were discharged the same day. There were no operative complications, and no readmissions were necessary. Within 6 months of surgery there were six pregnancies including one spontaneous abortion and five ongoing pregnancies. Of those not conceiving within 8 months, seven (100%) demonstrated tubal patency on a follow-up hysterosalpingogram. We conclude the laparoscopic approach to tubal sterilization reversal is a viable alternative to open abdominal microsurgical approaches. Although preliminary, laparoscopic surgery promises to be cost effective, as it can be performed on an outpatient basis, may reduce operative time and minimizes the recuperative period of patients.

Adult↗
PubMed1999

Advances in the diagnosis and treatment of thoracic trauma.

With the exception of the use of ECG to screen patients for blunt cardiac injury, recent advances in the diagnosis of thoracic trauma involve new technology. Use of surgeon-performed pericardial and pleural ultrasound for the detection of tamponade or hemothorax, TEE or spiral CT to diagnose rupture of the thoracic aorta, and thoracoscopy to evaluate a hemothorax or the integrity of the left hemidiaphragm are all standard techniques in modern trauma centers. In terms of treatment, emergency center thoracotomy is performed more selectively and with the adjunct of staple closure for cardiac wounds. Pulmonotomy is used selectively to control deep lobar hemorrhage and to avoid the need for an emergent lobectomy. Finally, nonoperative management of an intimal tear of the thoracic aorta or delayed operative management of a full-thickness tear in the patient with multiple injuries, using beta-blocker-induced relative hypotension, is rapidly becoming the standard of care throughout the United States.

Aortic Dissection↗
PubMed1997

Totally stapled restorative proctocolectomy.

BACKGROUND: Totally stapled restorative proctocolectomy (TSRP) has simplified ileoanal pouch surgery but few reports exist concerning experience with the technique. A retrospective study of operative and functional data in a consecutive series of patients undergoing TSRP was undertaken. METHODS: TSRP with J pouch formation was attempted in 103 patients between 1988 and 1995 (for ulcerative colitis (87 patients), familial adenomatous polyposis coli (nine), slow transit constipation (six) and hereditary non-polyposis colorectal cancer (one). Three technical failures resulted in 100 patients available for assessment. Case notes were reviewed together with functional assessment by clinical interview and/or postal questionnaire. RESULTS: Median operating time was 200 min, intraoperative blood loss 360 ml and hospital stay 12 days. There were no operative deaths. All but five patients (95 per cent) had loop ileostomy formation with subsequent reversal. There were 29 complications, six of which required further surgical intervention. Six pouches were excised and two patients had a temporary defunctioning ileostomy. Five patients were rediagnosed as having Crohn's disease, of whom four underwent subsequent pouch excision. Pouchitis (in the absence of Crohn's disease) occurred in eight patients (8 per cent). In 60 patients with at least 12 months of established function, median day and night stool frequencies were 5 and 1 respectively. Functional evaluation in 49 patients (82 per cent) revealed regular use of antidiarrhoeal medication in 21, urgency in 17, and total continence by day and night in 37 and 35 respectively. Fifty-three patients (88 per cent) were satisfied with the overall long-term outcome. CONCLUSION: TSRP is safe, has simplified a technically difficult operation and gives good long-term functional results.

Adenomatous Polyposis Coli↗
PubMedDate not supplied

Facilitating intracorporeal colorectal anastomoses.

BACKGROUND AND OBJECTIVES: An experimental study was undertaken to evaluate whether a previously described technique for laparoscopic sigmoid resection with intracorporeal resection-anastomosis and specimen removal via a suprapubic incision could be facilitated and applied to the rectum. METHODS: Ten domestic pigs (median weight 41 kg) underwent low anterior resection of the rectum, which was transected with an articulating endoscopic stapler. Pursestring sutures were fashioned intracorporeally with a laparoscopic pursestring clamp. The anvil of a circular stapler was inserted through a 33 mm port into the colon and pursestring tied intracorporeally. A circular gun with a spike fixed to its shaft was introduced per anum and a double-stapled anastomosis performed. RESULTS: Complete doughnuts were obtained in all cases and anastomoses were all methylene blue tight. All porcine subjects had an uneventful 5-week postoperative course. The median anastomotic level from the anal verge was 5.2 cm. Histology of colorectal anastomoses revealed healing mucosa. CONCLUSIONS: The use of articulating endoscopic stapler, laparoscopic pursestring clamp, and circular stapler with a spike fixed to its shaft seems to facilitate a previously described intracorporeal approach to sigmoid resection which was safely applied to the rectum in a porcine model.

Anastomosis, Surgical↗
PubMed2002

Pull-out and shear failure strengths of arthroscopic meniscal repair systems.

Meniscal repair is common and recommended in young patients. Suture techniques and fixation devices were developed for stronger, more facile repairs. Three devices (T-Fix, Meniscal Staple, Meniscus Arrow) were biomechanically compared to horizontal PDS suture. Peripheral tears were created in porcine menisci and repaired using the manufacturer's technique. An Instron was used to distract the menisci at 50 mm/min in axial-pullout and longitudinal shear loads. Load to failure curves and peak failure loads were noted. Load to failure in axially loaded pull-out mode was: Staple, 4.195+/-3.70 N; Arrow, 39.755+/-11.37 N; T-Fix, 45.892+/-13.99 N; Suture, 107.65+/-22.37 N. Analysis of variance with post hoc testing revealed Staple failure at lower load than all devices and Suture failure at higher loads than all devices; Arrow and T-Fix were similar. The data varied significantly from that obtained in shear. Shear loads to failure were: Staple, 8.39+/-8.62 N; Arrow, 27.67+/-14.33 N; T-Fix, 57.47+/-17.05 N; Suture, 64.15+/-17.05 N. Analysis of variance, power analysis, and pair-wise multiple comparisons revealed significant differences between: Suture and Staple, Suture and Arrow, and T-Fix and Staple. No differences were noted between Suture and T-Fix, T-Fix and Arrow, or Arrow and Staple. In pullout, Suture and T-Fix maintained better apposition at low loads. As load increased, the menisci separated until device failure. Arrows allowed low load separation but held tissue until failure. Staples failed at low load. For shear, the menisci attempted to reorient parallel to the force. The devices failed in a pull-slide pattern. Suture failed by pull-through. Meniscal repair devices are easy to use and may provide resistance to shear and pull out. The resistance to pullout loads was very different than the resistance to longitudinal shear loads.

Analysis of Variance↗
PubMed2001

A comparative study of buttressed versus nonbuttressed staple line in pulmonary resections.

BACKGROUND: Prolonged air leak is the major limiting factor in early hospital discharge following pulmonary resection. The purpose of this study was to determine whether the use of bovine pericardial strips as a buttress along the lung staple line would decrease air leaks and hospital stay after lobectomy and segmentectomy. METHODS: This was a multicenter trial consisting of 80 patients undergoing pulmonary resection, randomly assigned to the control group (40 patients) or treatment group (40 patients). The treatment group had reinforcement with bovine pericardium. RESULTS: No statistical differences were noted in the mean intensive care unit length of stay (p = 0.9), number of days with a chest tube (p = 0.6), or total length of stay (p = 0.24). Increased air leak duration was associated with assignment to the control group (r = 0.27, p = 0.02). The mean duration of air leak was 2 days and the mean time to chest tube removal was 5.9 days in patients with a buttressed staple line compared to 3 days and 6.3 days, respectively, for patients with nonbuttressed staple lines. CONCLUSIONS: Within the data of this study, no statistical differences were noted between buttressed and nonbuttressed patients. However, the trend toward shortened air leak time and tube removal time was apparent in the buttressed group. With greater number of patients studied, it is likely that the cost of bovine pericardium would be justified by shorter air leak duration and hospitalization.

Adult↗
PubMed1994

Removal of internal fixation--the effect on patients' complaints: a study of 66 cases of removal of internal fixation after malleolar fractures.

To estimate the effect of removal of internal fixation after treatment of malleolar fractures on postoperatively presented complaints, we retrospectively evaluated 66 patients by their records and by personal questionnaires. Of all the patients, 89.4% had one or more complaints. These were typically soreness over implant and cicatrix, reduced movement of the ankle joint, and strain-related pain. About 75% of these patients reported improvement after removal. The AO mode of fixation, i.e., typically by lateral semitubular plating and transsyndesmotic screw and a medial screw or pins, and the Wiberg-Cedell mode, i.e., typically consisting of lateral single or double cerclage and staple and medial pinning, constituted the principal groupings of the patients. The two groups were comparable. In this series, we found significantly more complaints associated with the AO mode in the postoperative period. We conclude that removal of internal fixation after malleolar fractures is indicated when common types of complaints are presented.

Adolescent↗
PubMed2005

Staple-line buttressing material in gastric-bypass surgery.

The problem of obesity has reached epidemic proportions in the USA. More than 50% of adults are obese or overweight. The only therapeutic intervention that provides effective long-term weight loss for the severely obese is bariatric surgery. Roux-en-Y gastric bypass is the most commonly performed bariatric operation in the USA. Anastomotic leaks can cause life-threatening sepsis in the immediate postoperative period or delayed presentations with fistulas. Fibrin sealant and bovine pericardium have been used to reinforce the anastomosis in order to decrease the rate of this dreaded complication. This review will summarize current literature on the subject.

Anastomosis, Surgical↗
PubMed2005

Duodenal dearterialization and stapling for severe hemorrhage from duodenal varices with portal vein thrombosis.

BACKGROUND: Hemorrhage from duodenal varices is a rare but frequently fatal cause of gastrointestinal bleeding. Portal vein thrombosis may worsen the bleeding and prevent access for reduction of variceal pressure. METHODS: A technique to control bleeding and reduce inflow pressure to the varices is described. It includes ligation of the gastroduodenal and splenic arteries, splenectomy, stapling of the duodenum, and gastroenterostomy. RESULTS: Three patients, hemodynamically unstable from duodenal hemorrhage, underwent the procedure. No further bleeding was encountered. One patient died of fungal sepsis and liver failure, but 2 are alive without further problems 21 and 24 months later. CONCLUSIONS: Reduction in arterial inflow, direct variceal ligation, reversal of hypersplenism, and food stream diversion are elements of this procedure that may have contributed the control of severe hemorrhage from duodenal varices associated with portal vein thrombosis.

Duodenum↗
PubMed1995

Study of endoscopic staple formation by specimen radiography on pulmonary wedges.

The advent in video-assisted thoracic surgery has rendered us to rely more and more on mechanical devices. We prospectively studied staple formation on resected lung specimen by radiography and attempted to correlate this with the clinical outcome. From February 1994 to January 1995, 36 consecutive pulmonary wedges (23 apical bullae, 12 pulmonary metastases, 1 tuberculoma) from 31 patients who had undergone resection by endoscopic staple-cutter (Endo GIA30, USSC) were examined by two-plane radiography for staple alignment and closure. Imperfect staple formation was found in 21 (58%) of resected specimens. The median size of the resected bullae is 4.2 mL (range, 2.0 to 58.8 mL) compared with 36 mL (range, 1.2 to 222.8 mL) in the resected metastases and tuberculoma specimen. Despite detecting more imperfect staples in the metastases group (77% vs 57%), there was little difference in the two groups with respect to postoperative chest drainage duration (median, 3 vs 2 days) or hospital stay (median, 2 vs 2 days). We conclude that the currently available endoscopic staplers are by no means perfect, especially for resection of larger specimens, even though this may not be apparent clinically. A continuous search for improvement in endoscopic staplers designed specifically for lung resection is needed.

Adolescent↗
PubMed2005

A modified stapling technique for performing Billroth I anastomosis after distal gastrectomy.

Autosuture staplers have provided various operative and postoperative benefits in gastrointestinal surgery. We describe herein our technique of performing distal gastrectomy followed by side-to-end gastroduodenostomy. Eighteen consecutive patients with gastric cancer underwent distal gastrectomy by the staple technique. We propose a modification of the stapling technique to reduce the number of devices used. In our technique, side-to-end anastomosis is performed first, followed by gastric resection just distal to the anastomosis. By introducing the stapler through the area to be resected, we can eliminate the need to close the gastrostomy. Anastomotic stricture occurred in only 1 (5.5%) of 18 cases. There have been no other postoperative complications related to the anastomosis. We believe that our technique is superior in simplicity and security to the conventional techniques.

Gastrectomy↗
PubMed2001

Early bursting strength of human colon anastomoses--an in vitro study comparing current anastomotic techniques.

An experimental in vitro study involving ten hand-sutured, ten biofragmentable anastomotic ring (BAR) and ten stapled anastomoses was conducted to compare current anastomotic techniques on the basis of early bursting pressure. The 30 fresh human colon segments used in the study were harvested from patients who had undergone elective oncologic resection. Following the construction of in vitro anastomoses, the pressure required to burst these specimens was measured. The results showed no significant differences among the three techniques. Since hand-sutured anastomoses proved to be as effective and reliable as the other methods and can offer the advantage of cost savings, they should remain standard procedure in colorectal surgery.

Adult↗
PubMed1996

The classic intrafascial Semm hysterectomy as an alternative to abdominal hysterectomy.

STUDY OBJECTIVE: To compare the classic intrafascial Semm hysterectomy (CISH) with abdominal hysterectomy. DESIGN: Retrospective analysis. SETTING: Community hospital. PATIENTS: The first 100 women with intractable uterine bleeding, leiomyomata, and chronic pelvic pain. INTERVENTIONS: The CISH procedure, initially with the Endo GIA stapler, but later, electrocoagulation and suture to lower costs and eliminate automatic staple complications. MEASUREMENTS AND MAIN RESULTS: Operating time for CISH decreased and our ability to remove larger uteri increased as we became more proficient. Complications were limited to one cystotomy and four transfusions. The average hospital stay was 36 hours and most patients were back to normal activity in 3 weeks. CONCLUSION: Our experience suggests that the CISH is organ preserving, is minimally invasive, decreases recovery time, and can be performed in women in whom an open abdominal approach once would have been the only option.

Adult↗
PubMed2002

Handsewn versus stapled anastomosis in penetrating colon injuries requiring resection: a multicenter study.

BACKGROUND: Although the use of stapling devices in elective colon surgery has been shown to be as safe as handsewn techniques, there have been concerns about their safety in emergency trauma surgery. The purpose of this study was to compare stapled with handsewn colonic anastomosis following penetrating trauma. METHODS: This was a prospective multicenter study and included patients who underwent colon resection and anastomosis following penetrating trauma. Multivariate logistic regression analysis was used to identify independent risk factors for abdominal complications and compare outcomes between stapled and handsewn repairs. RESULTS: Two hundred seven patients underwent colon resection and primary anastomosis. In 128 patients (61.8%) the anastomosis was performed with handsewing and in the remaining 79 (38.2%) with stapling devices. There were no colon-related deaths and the overall incidence of colon-related abdominal complications was 22.7% (26.6% in the stapled group and 20.3% in the handsewn group, p = 0.30). The incidence of anastomotic leak was 6.3% in the stapled group and 7.8% in the handsewn group (p = 0.69). Multivariate analysis adjusting for blood transfusions, fecal contamination, and type of antibiotic prophylaxis showed that the adjusted odds ratio (OR) of complications in the stapled group was 0.83 (95% CI, 0.38-1.74, p = 0.63). In a second multivariate analysis adjusting for blood transfusions, hypotension, fecal contamination, Penetrating Abdominal Trauma Index, and preoperative delays the adjusted OR in the stapled group was 0.99 (95% CI, 0.46-2.11, p = 0.99). CONCLUSION: The results of this study suggest that the method of anastomosis following colon resection for penetrating trauma does not affect the incidence of abdominal complications and the choice should be surgeon's preference.

Adolescent↗
PubMedDate not supplied

Treatment of leg length discrepancy with temporary epiphyseal stapling in children with juvenile idiopathic arthritis during 1957-99.

Temporary epiphyseal stapling is a flexible method for correction of leg length discrepancy. Due to a high risk of premature epiphyseal plate closure and other complications reported in previous studies, the technique has not been in wide use. In this study a retrospective analysis of 71 knees in patients with juvenile idiopathic arthritis was performed to determine the safety and effectiveness of the method. Only seven minor reversible complications were encountered, and the authors found the method suitable even for immunologically compromised patients.

Arthritis, Juvenile↗
PubMed1984

Tubes, wires, and rods seen in chest roentgenograms.

Different devices are seen on chest roentgenograms everyday. The gamut of metallic density shadows include sutures, surgical clips, staples, cardiac valve prosthesis, wires, and plates. Tubes and catheters are recognized when metallic wires or barium are incorporated in their walls. The number of devices is ever growing and with them complications grow. The radiologist may be the first to detect these complications. This article endeavors to review briefly a small number of these devices and their complications. References are provided for the avid reader.

Catheterization↗