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PubMedDate not supplied

Staple pneumoreduction with fibrin sealant application: a reliable method of transplanting oversized lungs.

Transplantation of a large lung allograft into a small chest could lead to atelectasis and hemodynamic instability. We developed a technique by which larger-sized lungs could be reduced to fit into smaller recipients. This entails multiple applications of a stapler device to progressively remove excessive lung tissue until the lung fits adequately into the recipient's chest cavity. An experimental animal model was used to test the applicability and safety of this technique. Because air leak from the resected margins was anticipated, we further examined the feasibility of reducing the latter by application of fibrin glue. Eight small mongrel dogs (20 to 25 kg) received left lung allotransplants from eight larger-sized dogs (35 to 40 kg) with the staple pneumoreduction technique. This group was further stratified to receive (group 1A; n = 4) or not receive application of fibrin sealant (group 1B; n = 4) to the stapled resection margins. Group 2 received lungs from similar-sized animals (20 to 25 kg; n = 4 each). Group 3 consisted of size-mismatched animals without pneumoreduction (n = 2). Recipient dogs were compared for facility of chest closure, gas exchange, and hemodynamic stability. The ability of the newly implanted lung to support respiratory function was also assessed by ligation of the opposite pulmonary artery at 4 hours. No difference was noted between groups 1 and 2 in terms of these variables. In sharp contrast, group 3 animals showed a rapid and profound drop in blood pressure after chest closure.(ABSTRACT TRUNCATED AT 250 WORDS)

Air↗
PubMed2004

Predictive factors of stenosis after stapled colorectal anastomosis: prospective analysis of 179 consecutive patients.

The incidence, risk factors, and clinical relevance of stenosis of stapled colorectal anastomosis (CRA) were studied prospectively. Anastomotic stricture was defined as the inability of traversing the anastomosis with the rigid proctoscope. The population studied consisted of 179 patients (94 males) with an average age of 59.3 years (range: 20 to 91 years). The main indication for surgery was colorectal cancer in 59% of the cases, followed by diverticular disease in 23%. The first endoscopic control was performed before 4 months in 25% of the patients, between 5 and 10 months in 50%, and during the following 10 months in 25%. Stenosis was verified with the rigid instrument in 21.1% of the cases and with the flexible colonoscope in 4.4%. The barium enema performed in 12 cases confirmed a punctiform stenosis in 5 patients, 4 of whom had been asymptomatic. An endoscopic dilatation was performed on 5 of the 8 symptomatic patients, with one relapse that required an additional dilatation. In the univariate analysis only the lesser 4-month interval was statistically significant (p = 0.033; odds ratio (OR) = 2.3; confidence interval (CI) 95% = 1.06 to 4.97). Male patients (p = 0.057; OR = 2.08; IC 95% = 0.97-4.44) show a tendency to CRA stricture that does not reach statistically significant levels. In the multivariate analysis, only sex (p = 0.04; OR = 4.11; IC 95% = 1.03 to 5.41) and the time interval (p = 0.012; OR = 2.87; IC 95% = 1.25 to 6.57) appear as independent variables in stenosis risk of a stapled CRA. The incidence of this complication depends on the criteria used for defining it. It is clinically relevant in no more than 5% of the patients. Five out of eight patients in category II were treated successfully with an endoscopic dilatation, while the other three improved spontaneously. Early stenosis, although frequent, is generally asymptomatic and disappears spontaneously. Considering the lack of correlation between the degree of stricture and its symptomatology, it is convenient to combine both the anatomic and the clinical criteria in the selection of candidates for an eventual therapeutic procedure.

Adult↗
PubMed1995

Anterior gastric wall stapling combined with posterior truncal vagotomy in the treatment of duodenal ulcer.

Anterior gastric stapling with posterior truncal vagotomy was examined as an alternative to highly selective vagotomy in the treatment of peptic ulcer disease. A clinical series of 32 patients who underwent the combined procedure is presented; gastric acid output was adequately reduced (basal output by 82 per cent, peak by 64 per cent). Motility changes were temporary and mild. Clinical follow-up, using a modified Visick grading, showed good to excellent results in 21 of 25 patients who could be classified. This procedure is suggested as an appropriate alternative to highly selective vagotomy.

Adult↗
PubMed2001

Laparoscopic supracervical hysterectomy with Filshie clips.

We conducted a retrospective study to evaluate the efficacy of Filshie clips for pedicle ligation during laparoscopic subtotal hysterectomy. The procedure was a combination of endoscopic stapling with lateral movement of the cartridge to the infundibulopelvic or ovarian ligaments, Filshie clips to uterine arteries, cutting diathermy to transect the cervix, and motorized morcellator to remove the uterine body. Two patients had postoperative spotting from the stump. Median return to home activity was 7.5 weeks (range 2-24 wks) and to work was 9.5 weeks (range 2-12 wks). Based on a questionnaire survey, all 12 women were satisfied with the operation. In those who were sexually active it was associated with improved sexual functioning in six and no change in four. (J Am Assoc Gynecol Laparosc 8(1):137-142, 2001)

Adult↗
PubMed2002

Linear stapling forms improved anastomoses during esophagojejunostomy after a total gastrectomy.

BACKGROUND: Circular stapling devices are commonly used to form esophagojejunal anastomoses after total gastrectomy. However, the technique has potential problems with placement of the purse-string suture and insertion of the anvil of the instrument. METHODS: We describe an improved technique for esophagojejunostomy by functional end-to-end anastomosis with linear stapling devices. RESULTS: Three patients with gastric cancer underwent this procedure after total gastrectomy. No anastomotic leakage or clinical evidence of stenosis was encountered. The maximum diameters of the anastomoses, evaluated by radiography with barium at 6 months after surgery, were 3.5 cm and 4.0 cm in 2 patients. Endoscopic examination revealed clear lines of anastomosis with a straight continuity between the distal esophagus and the jejunum. CONCLUSIONS: Our improved technique for esophagojejunostomy by functional end-to-end anastomosis with two linear staplers is a convenient, safe and reliable procedure that is independent of the width of the esophagus and the depth of the esophageal hiatus.

Anastomosis, Surgical↗
PubMed2001

Treatment of inguinodynia after laparoscopic herniorrhaphy: a combined laparoscopic and fluoroscopic approach to the removal of helical tackers.

Laparoscopic inguinal herniorrhaphy has become a popular operation for the treatment of inguinal hernia. However, injury and entrapment of the cutaneous nerves of the lumbar plexus by the staples or tackers used for mesh fixation have been described. Laparoscopic removal of the staples or tackers in the inguinal region has been attempted with variable success. The success of the laparoscopic approach for removal of helical tackers in particular is sometimes limited by the fact that the offending tackers are deeply embedded in the preperitoneal tissues and not readily located with a simple laparoscopic view. The authors report a case in which fluoroscopy was used to help identify tackers that could not be visualized laparoscopically. The neuralgia disappeared after successful removal of the offending tackers with no neurologic deficit. Liberal use of fluoroscopic guidance in the laparoscopic removal of helical tackers in similar cases is recommended.

Fluoroscopy↗
PubMed1996

Transsternal transpericardial operations in the treatment of bronchopleural fistulas after pneumonectomy.

Between 1972 and 1993, 19 patients (15 males and 4 females) with bronchopleural fistulae and pleural empyema after pneumonectomy were treated with transsternal transpericardial operations and closure of the fistula. The underlying malignant disease was a non-small cell carcinoma in 12, a malignant epithelial mesothelioma in two, and an atypical carcinoid tumor in one case. One patient each presented with tuberculosis, chest trauma, and lung destroyed by bronchiectasis. Fistulas affected the right bronchial stump in 17, and the left in 2, cases after pneumonectomy. The time between pneumonectomy and transsternal transpericardial operation ranged between 1 month and 4 years. All patients were submitted to drainage and irrigation of the empyema cavity (2-4 weeks). In 16 patients a long bronchial stump was sutured or stapled, in three cases resection of a short stump with the distal trachea was followed by anastomosis of the trachea and left main stem bronchus. Irrigation of the pneumonectomy cavity was continued in all patients for 2 weeks. Transsternal transpericardial operation was successful in 15 patients. Two patients died in the first 30 days, of renal or respiratory failure without fistula recurrence. In two cases the fistula recurred; definitive healing was achieved using a great omentum flap and endoscopic application of fibrin glue and bone spongiosa. Transsternal transpericardial management of bronchus stump fistula after pneumonectomy is highly effective and offers advantages over the direct approach through the infected empyema cavity.

Adult↗
PubMed2006

New techniques in the treatment of common perianal diseases: stapled hemorrhoidopexy, botulinum toxin, and fibrin sealant.

There have been several recent advances in the treatment of common perianal diseases. Stapled hemorrhoidopexy is a procedure of hemorrhoidal fixation, combining the benefits of rubber band ligation into an operative technique. The treatment of anal fissure has typically relied upon internal sphincterotomy; however, it carries a risk of incontinence. The injection of botulinum toxin represents a new form of sphincter relaxation, without division of any sphincter muscle; morbidity is minimal and results are promising. For the treatment of fistula in a fistulotomy remains the gold standard, however, it carries significant risk of incontinence. Use of fibrin sealant to treat fistulae has been met with variable success. It offers sealing of the tract, and then provides scaffolding for native tissue ingrowth.

Botulinum Toxins↗
PubMed2004

Stapled hemorrhoidectomy with local anesthesia can be performed safely and cost-efficiently.

PURPOSE: This prospective study was designed to assess the feasibility of performing the procedure for prolapsing hemorrhoids, or stapled hemorrhoidectomy, under local anesthesia supplemented with conscious sedation. METHODS: Seventy consecutive patients (mean age, 56 years; 37 males) with Grade 3 or 4 hemorrhoids underwent the procedure for prolapsing hemorrhoids after perianal infiltration of 0.5 percent lidocaine with 1:200,000 epinephrine and supplemental conscious sedation. The procedure was performed in an outpatient setting, with the patient being discharged within two hours of checking into the ambulatory facility. All patients were assessed the following day by telephone, and then in the office at three weeks and two months for degree of postoperative pain, bleeding, continence, and time back to work or social activities. Additionally, all excised mucosal anastomotic rings were analyzed for presence or absence of muscle. RESULTS: Each patient rated the pain as minimal or none. Five patients complained of mild, transient perineal pressure, and three complained of fecal urgency and seepage before their first office visit; one complained of external skin tags at the second office visit. All subjects were back to work or social activities within three to four days-most within 48 hours. Complications included urinary retention in five patients, two of whom had a concomitant urinary tract infection, and one had urosepsis requiring hospitalization. One patient required immediate reoperation for bleeding from the staple line. Another patient was admitted for postoperative bleeding and packed with a hemostatic agent the evening of surgery. Muscularis propria fibers were identified in 68 of 70 pathologic specimens. CONCLUSIONS: Administration of general, spinal, or epidural anesthesia for the procedure for prolapsing hemorrhoids is well described. This study suggests that the use of local anesthesia supplemented with conscious sedation for the procedure for prolapsing hemorrhoids yields results equivalent to those achieved with general or regional anesthesia without the attendant risks and additional costs. This study also suggests that the presence of muscle fibers in the pathologic specimen does not seem to lead to increased pain or impaired continence, although it was not specifically designed to address this issue.

Ambulatory Surgical Procedures↗
PubMed2002

Primary mechanical stapled anastomosis in surgery for colorectal emergencies.

From May 91 to March 99 a consecutive series of 100 acute obstructions or perforations of the left colon or rectum were treated by primary resection with mechanical anastomosis using a double or triple stapling technique without proximal colostomy. There were 8 postoperative deaths (8%) due to sepsis, acute respiratory distress syndrome, pulmonary embolism, stroke, and cachexy. Complications occurred in 29% of surviving patients. Clinical anastomotic leaks were observed in 7%, respiratory infection in 8%, wound infection in 8% and major cardiovascular problems in 4% of patients. The median hospital stay was 19 days. The morbidity and mortality of this series did not exceed the cumulative morbidity and mortality that can be expected after staged surgery. Compared with staged surgery, immediate resection and anastomosis using an entirely mechanical suture, thereby avoiding the problems of colostomy and reducing the length of hospital stay, has significant advantages for patients.

Aged↗
PubMed2001

Staple-line reinforcement with a new type of polyglycolic acid felt.

Although various materials have been used for reinforcement in lung-volume-reduction surgery to buttress pulmonary staple-line, absorbable materials are not available for use in thoracoscopic surgery. Moreover, even nonabsorbable types of reinforcements have been used only for lung volume reduction surgery. However, elderly patients with spontaneous pneumothorax secondary to emphysematous lung are well treated with staple-line reinforcement. The authors developed a new type of polyglycolic acid felt to buttress staple-line. This felt is absorbable, easier to cut with a stapler knife than is the conventional polyglycolic acid felt, and inexpensive enough to use for various types of thoracic surgeries for emphysematous lungs in Japan, and it can be attached to staplers with a small amount of fibrin glue. These strips were used to reinforce pulmonary staple lines for resection of emphysematous lungs in 14 patients: pulmonary emphysema (n = 1), bilateral giant bullae (n = 1), ipsilateral giant bullae (n = 6), spontaneous pneumothorax with multiple bullae in an emphysematous lung (n = 5), and lung cancer in a patient with pulmonary emphysema (n = 1). There were no air leaks during surgery. Air leaks were noted in three patients after surgery. In two patients, the air leaks stopped within 2 weeks. In one patient, the air leak was found to originate from an untouched lobe during reoperation. No infection or allergic reaction developed in a patient during a mean follow-up of 12 months (range, 1 to 24 months).

Humans↗
PubMed1997

The impact of the development of restorative proctocolectomy on the management of inflammatory bowel disease in the north of Scotland.

In the North of Scotland, 40 out of 196 patients who had surgery for colitis between 1986 and 1992 underwent restorative proctocolectomy. The problems of the development of experience in a new technique were reduced by cooperation between two consultant surgeons from centres 100 miles apart who performed the first 30 operations together. Over 7 years, the standard operative technique evolved from perimuscular dissection of the rectum with formation of an S pouch and hand sutured endo-anal anastomosis to perimesenteric rectal dissection with a stapled J pouch and double stapled anastomosis. There was no mortality and no pelvic sepsis requiring urgent re-operation. One pouch has been removed subsequently because of Crohn's disease. One patient required revisional surgery for severe stricture of the ileo-anal anastomosis. At 1 year post-operatively, 35 out of 40 patients were highly satisfied with the result of surgery. The proportion of patients undergoing restorative proctocolectomy rather than panproctocolectomy for ulcerative colitis has risen from 15 to 52%. The number of total colectomies performed as initial procedures for colitis has increased. The age of patients who have restorative proctocolectomy has widened to include teenagers as well as a few patients over 50 years of age.

Adolescent↗
PubMed1994

The stapled continent ileocecal urinary reservoir in the surgical management of gynecologic malignancy.

Total cystectomy at the time of radical pelvic surgery for gynecologic malignancies is not uncommon. Many techniques have been developed for urinary diversion including the continent ileocecal urinary reservoir. Twenty-nine patients underwent construction of a continent ileocecal urinary reservoir during the reconstructive phase of an exenterative procedure or for the relief of urinary tract fistula between 1990 and 1993. All procedures were performed using the mechanical stapling devices using metal staples. The right and proximal transverse colon were mobilized to a length of 24 cm. The ileum was divided 8 cm proximal to the ileocecal valve and plicated using the stapling technique. The colonic segment was opened on its antimesenteric border and the reservoir was created by stapling in a fashion to reapproximate the distal ends to each other. The ureters were stented and implanted without tunneling. A large Malecot drain was placed in all the pouches for irrigation of the colonic mucosa in the postoperative period. The ileal stoma was fixed to the anterior abdominal wall as was the anterior surface of the pouch. Operative time ranged from 50 to 150 min for the pouch construction. All patients underwent retrograde contrast study of the pouch 7-10 days postoperatively to verify lack of anastomatic leaks. After recovery, all patients successfully self-catheterized the pouch three to five times daily without difficulty. Of the 29 patients, 17 (59%) had received prior radiation as part of therapy. All patients remained continent at the end of observation. One developed a fistula to the perineum after intraoperative placement of 125I seeds on the pelvic wall. One patient developed pouch stones; endoscopic evaluation of this pouch revealed no evidence of stones at the staple lines and metabolic workup demonstrated hypocitremia as the etiology for the stones. Mean reservoir volume was 550 ml. Mean follow-up is 15.8 months; 5 have expired due to recurrent disease and 19 (83%) remain alive. Only two patients have been admitted for urosepsis due to reflux pyelonephritis. The stapled continent ileocecal reservoir offers benefits to patients undergoing total cystectomy. Using the mechanical stapling devices decreases the operative time and has not resulted in stone formation or pouch leakage. The complications of the procedure are acceptable.

Adult↗
PubMed1998

Reconstruction after total gastrectomy by the interposition of a double jejunal pouch using a double stapling technique.

BACKGROUND: After total gastrectomy, sustaining good nutrition is extremely important for maintaining quality of life. A technique of neogastric pouch formation based on current physiological reconstructive principles is presented. METHODS: The use of a modified interpositioned double jejunal pouch following total gastrectomy in 18 patients with cancer was reviewed. This technique results in a complete pouch and uses a double stapling technique with site-specific anastomosis between the oesophagus and pouch, in which a Hisoid angle is created. RESULTS: There were no anastomotic leaks and pouch blood flow was within normal expected limits. Mean oesophageal pH above 7.0 for one 24-h period was 7.7 per cent. Emptying half-time was 67.8 min. After 2 years mean body-weight was 98.3 per cent of expected, mean food volume was 94.0 per cent of expected and mean meal frequency was 3.0 per day. CONCLUSION: This form of gastric reconstruction is an acceptable procedure which improves the quality of life in patients undergoing total gastrectomy.

Adult↗
PubMed2004

Stenosis of the gastroenterostomy after laparoscopic gastric bypass.

BACKGROUND: Stenosis of the gastroenterostomy after laparoscopic Roux-en-Y gastric bypass (LRYGBP) is a serious problem that occurs after stapled (linear or circular) and hand-sewn anastomoses. METHODS: Data was prospectively entered into a database to track complications of bariatric surgery. Between Feb 27, 1999 and June 13, 2000, 1000 patients underwent LRYGBP. All patients met NIH criteria for bariatric surgery.The gastroenterostomy was constructed with a linear stapler inserted to 20 mm (15 mm cut). The stapler defect was closed with a polyester running suture to construct a 12-mm diameter anastomosis. The anastomosis was banded with fascia lata to prevent late enlargement. All patients with suspected stenosis were endoscoped. RESULTS: 32 patients (3.2%) developed stenosis (<10 mm diameter orifice) at the gastroenterostomy. There were 27 females. Average age was 44.8. Average BMI was 45.0. Average stenotic orifice was 5.7 mm in diameter. Stenoses occurred in 18 of 32 patients (56.3%) by 3 months, 26 (81.3%) by 6 months, and 31 (96.9%) by 1 year. 30 of the 32 patients underwent endoscopic dilation as initial therapy. 17 of the 32 underwent multiple dilations. Dilation caused 4 perforations, resulting in 2 emergency operations. Perforation occurred at the first attempt at dilation in 3 of 4 patients. Stenoses could not be successfully dilated in 8 patients, and all 8 underwent surgical revision. There were no deaths in these 32 patients, but there were 68 dilations and 10 re-operations. CONCLUSION: Stenosis of the gastroenterostomy after LRYGBP is an infrequent but serious problem, which results in considerable morbidity.

Adult↗
PubMed1995

Use of the double-stapling technique in esophageal surgery.

This study was conducted to examine the effectiveness of the double-stapling technique (DST) for performing esophageal anastomoses. A total of 17 patients, 10 with esophageal cancer and 7 with gastric cancer, underwent esophageal anastomosis employing this technique. Of the ten patients who underwent esophageal operations, eight received esophageal-gastric tube anastomosis, one esophageal-colon and colon-residual stomach anastomosis, and one pharyngeal-gastric tube anastomosis, while all seven of the patients who underwent operations for gastric cancer received esophagojejunostomy. Thus, a total of 18 anastomoses were performed. No problems were encountered during the anastomoses, and no leakage occurred in any of the patients. Thus, we conclude that DST is a safe and easy technique for performing esophageal anastomosis, especially intrathoracic or intramediastinal anastomoses.

Anastomosis, Surgical↗
PubMed1998

[Vertical gastroplasty as a treatment method in morbid obesity].

Since November 1992 in the RRCS. RAMS 38 patients aged 16-61 years (mean body mass 149.9 kg) for obesity of 3-4 grade underwent operation of vertical gastroplasty (VGP) by E. Mason's method. In 78.9% of patients uncomplicated course of early postoperative period was observed. One patient died due to thromboembolism of pulmonary artery. Two patients underwent regastroplasty due to tearing away of the staples of vertical mechanical suture and restoration of body mass (BM). Up to now stabilization of BM was detected in 19 patients. In this group mean values of surplus BM lowering made up 54.1% and maximal--60.1%. Positive influence of performed operations on the course of majority of the concomitant diseases in the absence of serious metabolic after-effects was observed. Initial results of operations seemed to be favourable, but for final conclusions about the effectiveness of VGP in far off period the accumulation of the experience and prolongation of follow-up period together with standardization of operation procedure are necessary.

Adolescent↗
PubMed1998

Buttressing staple lines with bovine pericardium in lung resection for bullous emphysema.

The utility of buttressing an endoscopic mechanical stapler with strips of bovine pericardium in resection of pulmonary bullous areas was evaluated by comparing the duration of air leakage in two randomized patient groups, one with and one without buttressing. The duration of air leakage was not related to bulla size in either group but showed a linear relation with the radiologic emphysema score in both groups (p < 0.001) and was shorter when the stapler had been fitted with bovine pericardium, but significantly reduced (p = 0.019) only in patients with a high emphysema score. The duration of air leakage was thus related to emphysema score, and in patients with high scores was shortened by application of bovine pericardium to the stapler.

Adult↗