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At least 1,243 records · Page 69Linked to original sources
PubMed2005

Interrupted micro-mattress sutures solve vessel-size discrepancy.

Although technical refinements have improved microvascular techniques, the problem of vessel-size discrepancy between donor and recipient vessels is still unsolved and can decrease the success rate of free tissue transfer. In fact, if vessels with incongruent diameters are not adequately anastomosed, the risk of free flap failure is increased. In this paper, the authors present a new type of microvascular anastomosis to overcome the problem of vessel-size discrepancy. Interrupted mattress sutures are placed in end-to-end anastomosis narrowing the wider diameter and compensating for the diameter incongruency. The surgical technique and main clinical applications of the interrupted micro-mattress sutures are described in detail. Indications and advantages are discussed.

Anastomosis, Surgical↗
PubMed1996

Comparison of three-dimensional and two-dimensional laparoscopic video systems.

The limitations of two-dimensional (2D) video may be overcome by the recent introduction of the three-dimensional (3D) laparoscope and video system. Twenty-two urologic and gynecologic surgeons experienced in laparoscopy were evaluated during a live porcine laboratory session in an advanced course designed to teach laparoscopic retroperitioneal nephrectomy and bladder neck suspension. The surgeons performed dissection of the kidney, securing of the renal vessels, laparoscopic suturing and intracorporeal knot-tying at the bladder neck, and suture clipping of an intracorporeally placed suture at the bladder neck using 2D and 3D equipment. The time needed to complete each technique was recorded and compared using nonparametric analysis. The participants' subjective evaluation of the 3D system was also analyzed. Three-dimensional video did not significantly improve the surgeons' ability to perform laparoscopic dissection of the kidney, securing the renal vessels, or laparoscopic suturing and knot-tying. Surgeons felt that the 3D system did not improve vision or perceived surgical performance sufficiently to justify an expense greater than that of the 2D systems now available. Compared with the standard 2D camera system, the currently available 3D video system does not hasten the laparoscopic dissection of tissues or the performance of advanced technical maneuvers such as laparoscopic suturing and knot-tying by experienced laparoscopists.

Adult↗
PubMed1992

Influence of the distance between interrupted sutures and the tension of sutures on the healing of experimental colonic anastomoses.

Certain technical factors determine the success of the creation of intestinal anastomoses. The influence of the distance between interrupted sutures and the suture tension on wound healing was investigated in an experimental study using a specially designed suture model. The combination of a long suture distance (group A, 2.5 mm) and a short suture distance (group B, 1.5 mm) with three different suture tensions, i.e., (1) no tension; (2) moderate tension; and (3) high tension, resulted in six different techniques. Tension was created by means of a spring balance. The anastomoses were examined macroscopically, histologically by microangiography, and by bursting pressure. Apposition of the bowel wall between the interrupted sutures was inappropriate due to prolapse of the mucosa in 7.9% of the patients in group A but did not occur in groups B2 and B3. The leakage rate was 4.6% in group A and 1.3% in group B. Early healing of the mucosa was noted in group B2. Bursting pressure was significantly higher on day 2 and 4 in groups B2 and B3. The results demonstrate the influence of suture technique on the wound healing of intestinal anastomoses. The best healing pattern was achieved by a small distance between the sutures and a moderate suture tension.

Anastomosis, Surgical↗
PubMed1997

Treatment of cervical incompetence by transabdominal cervicoisthmic cerclage.

Cervical incompetence is a condition traditionally treated by cervical cerclage which in most cases is inserted via the transvaginal route. However the insertion of a transabdominal cervicoisthmic suture is indicated in those patients with recurrent mid-trimester losses due to an incompetent cervix where it is not technically possible to insert a transvaginal suture. Between 1987 and 1996, 12 women at the Royal Women's Hospital, Melbourne were treated with transabdominal cervicoisthmic cerclage (TCC). Eight patients had cerclage in the nonpregnant state, and 4 were pregnant at the time. The completed pregnancies thus far have resulted in 10 surviving infants, a successful pregnancy rate of 69.2%. This compares favourably with a corrected preTCC successful pregnancy rate of only 13%. There were minimal intraoperative complications in our series. Bleeding, chorioamnionitis and premature rupture of the membranes have been reported elsewhere and occurred in 2 of our patients. Our results and a review of the literature confirms that TCC has an important role in carefully-selected patients.

Adult↗
PubMed1996

New technique in managing ureteropelvic junction obstruction: percutaneous endoscopic pyeloplasty.

Endopyelotomy is currently advocated for management of the obstructed ureteropelvic junction (UPJ). Healing of the stented UPJ occurs by secondary intention. Regardless of the method employed, success rates approach 85%. In order to increase the rate of success, we have devised a method of performing endopyelotomy in conjunction with endoscopic suturing of the incised UPJ. Two methods were developed to allow for the placement of a single absorbable monofilament suture. In the first method, endopyelotomy is carried out in the standard antegrade manner, and endoscopic suturing is performed with the use of a second retroperitoneal access sheath at the UPJ. In the second method, endoscopic placement of the suture is carried out through the standard renal access sheath, with suturing performed via the nephroscope. We have performed endoscopic pyeloplasty in eight patients. With a mean follow-up of 12 months, the procedure was successful in seven of these patients. Endoscopic suturing of the UPJ is technically demanding, but once sufficient expertise is gained, it may be utilized for immediate tissue coaptation, possibly decreasing urinary extravasation and, it is hoped, maximizing the caliber of the UPJ.

Adult↗
PubMed1996

Manual versus mechanical esophagogastric anastomosis after resection for carcinoma: a controlled trial. French Associations for Surgical Research.

BACKGROUND: Mechanical anastomosis has been claimed to reduce the rate of leakage compared with manual anastomosis. No randomized trials have been performed to date to prove this specifically in esophagogastric anastomosis. METHODS: One hundred fifty-four patients, 139 men and 15 women ranging in age from 36 to 83 years (mean, 50 +/- 10 years) and undergoing elective resection of esophageal or cardial carcinoma, were included in this multiinstitutional (14 centers) randomized study comparing the rate of anastomotic leakage after esophagogastric anastomosis performed manually or mechanically. Eligible for this study were patients with esophageal or cardial carcinoma located between the esophagogastric junction (included) and the upper border of the aortic arch. The choice between resection with or without thoracotomy was left to the discretion of the operating surgeon. Proximal resection of the fundus was mandatory. Intestinal tract continuity was reestablished in a one-stage procedure by an esophagogastric anastomosis without interposition of either the jejunum or the colon. The site of the anastomosis could be either intrathoracic or cervical. The principal end point was anastomotic leakage as judged by (1) egress of intestinal fluids or orally ingested methylene blue through drains, (2) sodium diatrozate swallow prescribed either routinely for all patients between postoperative days 3 and 8 or because of signs of leakage, or (3) reoperation or autopsy. RESULTS: After two patients were withdrawn for protocol violation, 152 patients, 74 in the manual group and 78 in the mechanical group, were studied. The number of anastomotic leakages was identical in both groups (n = 12, 16% and 15%, respectively). Overall 30-day mortality was 11%. Fewer deaths occurred in the manual group (7%), which had three anastomotic leakages, than in the mechanical group (15%), which had five anastomotic leakages, and fewer repeat operations were done in the manual group (n = 9) than in the mechanical group (n = 13), but both of these differences were not statistically significant. The duration of anastomosis and of operation was similar in both groups. In the mechanical group 16 anastomoses (20%) gave rise to technical mishaps (either in the fashioning of the purse-string, dilation of the esophagus, or in stapling). Among the factors recognized as potentially preventing leakage, only testing for airtightness was significantly correlated with less postoperative leakage (p < 0.05). Eight postoperative strictures were recorded at 3 months in 62 (13%) patients in the manual group, whereas seven strictures occurred in 53 (13%) patients in the mechanical group. CONCLUSIONS: When mechanical staples rather than manual sutures are chosen, the disadvantages (technical mishaps and higher costs) are not counterbalanced by a gain of time or a decrease in the rate or severity of anastomotic leakage.

Adult↗
PubMedDate not supplied

[Treatment of pilonidal disease using an LLL-plasty technic. Apropos of 27 cases].

The authors report 42 cases of pilonidal cyst on which 27 have been operated with the L-shaped skin graft "LLL-plasty". This technic has been applied to large pilonidal lesions, half of which were failures of other methods. Though the excision was large, the suture was easily practised with this technic. The healing time is around 13 days. The rate of relapse is small, but could be improved with more rigor in the indication and with constant medical supervision of the patients, imposing strict hygienic rules.

Cicatrix↗
PubMed1993

Stapled vs hand-sutured ileoanal anastomosis in restorative proctocolectomy. A prospective, randomized study.

A prospective, randomized study of hand-sutured (group 1, n = 19) and double-stapled (group 2, n = 21) ileoanal anastomosis was carried out in 40 consecutive patients during restorative proctocolectomy to compare complications and functional outcome. Eight patients (42%) in group 1 and 12 (57%) in group 2 had one or more complications. Four patients in group 1 and five in group 2 developed pelvic sepsis. One stapled anastomosis had to be converted to a hand-sutured one because of severe anastomotic stricture. Four patients in group 1 and eight in group 2 had no nighttime evacuations 3 months after surgery and seven patients in group 1 and 11 in group 2 had no nighttime evacuations six months after surgery. Mucous leakage occurred in two vs five patients after 6 months in groups 1 and 2, respectively. The mean resting anal pressure decreased 30% in group 1 and 28% in group 2. In conclusion, double-stapled ileoanal anastomosis does not offer any functional or technical advantage over hand-sutured anastomosis, but it does leave some of the disease behind.

Adenomatous Polyposis Coli↗
PubMed2006

Externalized urachal suture: novel approach to bowel and bladder retraction during transperitoneal laparoscopic radical prostatectomy.

INTRODUCTION: Although laparoscopic radical prostatectomy (LRP) has emerged as a legitimate minimally invasive surgical alternative to open radical retropubic prostatectomy, the technical difficulty of this advanced laparoscopic procedure remains an obstacle to its widespread use. We report a novel surgical technique for the purpose of bowel and bladder retraction during transperitoneal LRP that improves visualization and negates the need for additional working ports or steep Trendelenburg positioning. TECHNICAL CONSIDERATIONS: A 35-cm absorbable suture is secured intracorporeally to the urachus. The distal end of the suture is then pulled out through the left subcostal abdominal wall in the midaxillary line using a Carter-Thomason CloseSure device. Application of tension on the suture retracts the bladder superiorly and prevents bowel from entering the surgical field. This maneuver provides excellent exposure of the bladder neck and prostate and minimizes the need for additional fan retraction or steep Trendelenburg positioning. In 20 consecutive procedures, this step added an average of 2.2 minutes to the operative time, which averaged 169 minutes overall. CONCLUSIONS: Incorporation of an adjustable externalized urachal suture allows for excellent retraction of both bowel and bladder. This allows transperitoneal LRP to be performed using a four-port approach with minimal need for additional retraction or steep Trendelenburg positioning. In light of these benefits, the urachal suture has been incorporated as a routine step in transperitoneal LRP at our institution.

Humans↗
PubMed2006

Pediatric partial cricotracheal resection: a new technique for the posterior cricoid anastomosis.

OBJECTIVE: Partial cricotracheal resection has become a more popular procedure in the pediatric population as a treatment for severe subglottic stenosis. We describe a new technique for the posterior cricoid anastomosis. STUDY DESIGN AND SETTING: This is a case series of 4 pediatric patients with a Myer-Cotton grade III or IV subglottic stensosis. SETTING: Tertiary care hospital with a pediatric intensive care unit. RESULTS: All 4 patients were decannulated and there were no observed complications to include posterior mucosal dehiscence and/or recurrent laryngeal nerve injury. CONCLUSIONS: Placing sutures through the cricoid cartilage is technically less difficult than previously described techniques for treating subglottic stenosis near the undersurface of the true vocal folds and affords a more stable posterior mucosal suture line. SIGNIFICANCE: This technique provides a surgical means to treat high subglottic stenosis that closely approximates the true vocal folds by enabling a stable posterior mucosa to mucosa apposition. EBM RATING: Grade C-4.

Anastomosis, Surgical↗
PubMedDate not supplied

[Use of the EEA stapler in surgery of the rectum and rectosigmoid junction].

The application of mechanic sewing apparatus has obtained significant position in surgery of gastrointestinal tract. The EEA stapler (ILS Proximate) is improved, suitable and useful instrument for the performance of anastomosis after resection, and technically is equivalent to the normal suture techniques. It is especially convenient for the creation of low rectal anastomoses, thus definitive anus preter can be avoided. In 10 cases of rectal carcinoma, anterior resections and stapled anastomoses (3 were below 7 cm from anal border) were applied. In spite of insufficient number of surgically treated cases, surgical treatment was without technical problems and without postoperative dehiscence. Especially at low anastomoses, the importance of satisfactory suture techniques, adequate vascularization, avoidance of tissue tension, adequate selection and regulation of instruments are emphasized.

Anastomosis, Surgical↗
PubMed1997

[A single-stage double-layer suture for restoration of the uterine wall in cesarean section--our experience].

The author report, that in the Clinic of Obstetric & Gynaecology--St. Zagora, since 15 years, the uterine wall was reconstructed in two stories during caesarean section with continued catgut stitches. From 1990 they set the task to study prospectively the results of using the new surgical technics--one-stored, two-layered suture for reconstruction of the uterine wall during caesarean section. The received results of this method at 71 patients for 4 years & 5 months are very good and they confirm the effectiveness of one-stored, two-layered suture. The task is to enlarge the limits of using this technics from the others assistants in the clinic.

Catgut↗
PubMed1995

The use of cyanoacrylate tissue adhesive in high-risk intestinal anastomoses.

The success of every intestinal surgical procedure primarily depends on correct technical execution of the intestinal sutures. Despite the continuing improvements in intestinal synthesis techniques and the introduction of mechanical staplers, the risk of anastomotic dehiscence remains a major concern. For high-risk anastomoses, defined as those performed under critical conditions, n-butyl-2-cyanoacrylate tissue adhesive allows for quick sealing of the two stumps and supports the physiological wound-healing process. Furthermore, no experimental or clinical studies have shown that this glue has any carcinogenic or mutagenic properties. Thus, we believe that n-butyl-2-cyanoacrylate will be extremely useful for intestinal anastomoses with a high risk of dehiscence.

Anastomosis, Surgical↗
PubMed1990

Implantation of the distal aorta: a technique for preservation of pelvic blood flow in aortofemoral reconstruction.

We report our initial experience with a previously undescribed variation of aortofemoral bypass. This technique is an alternative to end-to-side aortic anastomosis for preservation of pelvic blood flow. It involves an end-to-end proximal aortic anastomosis with implantation of the distal aorta into the posterior wall of the bifurcation graft. This approach has been used selectively for nine patients. Seven patients operated on using this technique had bilateral external iliac artery disease preventing retrograde perfusion of the pelvis. We used this procedure in two other young patients to preserve large inferior mesenteric and distal aortic lumbar vessels proximal to common iliac artery occlusions. Mean follow-up has been 20 months. There have been no deaths and no major complications. This technique provides the hemodynamic benefit of a proximal end-to-end aortic anastomosis while maintaining patency of the distal aorta and its branches. Additional technical advantages may include better suture line protection from the duodenum and a decreased potential for graft limb kinking. These factors may ultimately result in superior long-term graft patency.

Adult↗
PubMed2004

Laparoscopic ovarian suspension to facilitate surgery for advanced endometriosis.

OBJECTIVE: To describe a new laparoscopic technique that exposes the ovarian fossa and pelvic side wall by suspending the ovaries to the anterior abdominal wall for advanced endometriosis surgery. DESIGN: Report of an operative technique. SETTING: University teaching hospital. PATIENT(S): More than 50 women operated on for endometriosis over the last 2 years. INTERVENTION(S): Laparoscopic suspension of one or both ovaries to the abdominal wall with transabdominal 2-0 polypropylene suture. MAIN OUTCOME MEASURE(S): Technical feasibility. RESULT(S): The technique is easy to perform in a short period of time. CONCLUSION(S): In cases in which a good exposure to the ovarian fossa is needed, this technique can be performed in a short period of time without the need of an assistant.

Endometriosis↗
PubMed2004

A simple and reliable hemostatic technique during partial nephrectomy.

INTRODUCTION: To report our experience with a refined technique for hemostasis that obviates the need for vascular control and closure of the collecting system in partial nephrectomy. TECHNICAL CONSIDERATIONS: Four to five sutures, 2 cm apart, are placed 0.5 cm from the anticipated parenchymal incision border, using a specially designed, blunt-tip, straight needle with folded 2-0 Vicryl thread. The needle is removed, leaving the Vicryl thread with the loop on one side of the kidney and two free ends on the other side. A 1.0-cm-wide Vicryl mesh strip is passed circumferentially through the loops and between the free ends on each side, tension is applied on the strip during knotting of the free ends of the thread, and the tissue is incised. No additional hemostatic sutures are necessary. No attempt is made to identify and close the open collecting system. Vascular clamping and surface cooling are avoided. Sixty-one patients have undergone this technique since 1987: initially, for complicated nephrolithiasis (n = 15), localized purulent kidney disease (n = 4), trauma (n = 3), congenital anomalies (n = 2), and resection of horseshoe kidney (n = 6) and, recently, for peripherally located renal tumor (n = 31). Upper pole resection was performed in 11 patients, lower pole resection in 45, and middle segment resection in 5. The blood loss was minimal, with only 1 patient developing gross hematuria that resolved after conservative treatment. No other complications occurred. CONCLUSIONS: A simple and easily performed hemostatic method suitable for peripherally located and, particularly, polar renal tumors is described. The Vicryl mesh strip prevents tears of the parenchymal sutures and ensures good hemostasis without closing the collecting system separately.

Hemostasis, Surgical↗