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PubMed2002

Sutureless coronary anastomosis with an anastomotic device and tissue adhesive in off-pump porcine coronary bypass grafting.

OBJECTIVE: In the search for a facilitated coronary artery anastomosis, we assessed the feasibility of a hybrid anastomosis technique that used a prototype anastomotic device with an extraluminal frame (crinoline-like) and octyl-cyanoacrylate adhesive. METHODS: During off-pump coronary artery bypass grafting in pigs (n = 8), a left internal thoracic artery-right coronary artery anastomosis was constructed and evaluated during the operation and at 5 postoperative weeks. The anastomosis was examined by flow measurement, angiography, intraluminal cast geometric analysis, and histologic analysis. RESULTS: Anastomosis construction required 6.2 +/- 1.3 minutes (mean +/- SD). At 5 weeks all anastomoses were fully patent, with minor anastomotic diameter narrowing (median 16%, 15th-85th percentile 16%-26%). After 30-second graft occlusion, median peak hyperemic flow response was 5.0 (15th-85th percentile 4.4-6.5). As a result of complete, streamlining filling of anastomotic wall recesses by neointima formation, more intimal hyperplasia was found in the crinoline-adhesive anastomoses than in sutured control anastomoses. No excessive, lumen-narrowing neointima formation was observed, however. CONCLUSIONS: The hybrid coronary anastomosis technique was feasible without any need for dedicated application tools. If technical improvements can be realized, the hybrid technique may provide an alternative to manual suturing.

Anastomosis, Surgical↗
PubMedDate not supplied

Chromic suture material as a nidus for common duct stone formation.

Several surgeons have reported finding silk suture material as a nidus for common duct stones after cholecystectomy. They have therefore advocated the use of chromic sutures to ligate the cystic duct in order to avoid this complication. A case report is presented in which chromic suture material was found to be the source of common duct stone formation after cholecystectomy. A review of the literature indicated the relative infrequency of foreign suture material causing this problem. The suture used in the routine ligation of the cystic duct should be left to the technical preference of the surgeon.

Aged↗
PubMed1981

Treatment and prevention of complications after extravesical antireflux technique.

An extravesical antireflux technique was performed in 300 consecutive patients who presented primary vesicoureteral reflux (VUR). The following results are reported: Elimination of VUR in 99% of the cases without complications. Early complications reported include: urinary retention, suppurative pyelonephritis and fistulae. Urinary retention occurred in 2 patients presenting other congenital abnormalities. Vesicocutaneous fistulae occurred in 2 patients due to obstruction of the catheter for vesical drainage; they closed spontaneously under adequate drainage of the bladder. Suppurative pyelonephritis and/or anuria occurred in 6 patients due to transitory obstruction due to edema of the new vesicoureteral junction and were treated with bilateral nephrostomy and progressed with good results after withdrawal of the nephrostomies. Late complications included: persistence of VUR in 8 patients due to two types of technical failure, too short a tunnel and dehiscence of the muscular suture; obstruction of the new vesicoureteral junction in five ureters due to three causes, excessive dissection of the ureters, mucosal stenosis and stenosis of the new hiatus; contralateral reflux in 6 patients due to nonsystematical performance of endoscopic examination of the ureteral meatus preoperatively in the first series of 100 consecutive cases. On the basis of the results achieved, the authors give specific suggestions that allow the technical prevention of the small number of complications that may occur using the extravesical antireflux technique in the treatment of VUR.

Anuria↗
PubMed1997

An improved technique for a stapled transabdominal esophagojejunostomy.

BACKGROUND: In the performance of a stapled transabdominal esophagojejunostomy there are two main technical problems involved and related to a difficult surgical exposure. One is the placement of the purse-string suture and the second is the insertion of the anvil of the circular intraluminal stapler into the distal esophagus. METHODS: These technical difficulties can be overcome by opening just the anterior wall of the esophagus at the anastomosis level, leaving the posterior wall intact. RESULTS: The integrity of the posterior wall avoids retraction of the mucosa, allowing the esophagus to remain opened for the placement of a through and through purse-string suture under direct vision. It also acts as a conduit for the insertion of the anvil of the circular intraluminal stapler. CONCLUSIONS: The technique described herein avoids stay sutures, purse-string instruments, and forceful instrumental dilatation of the distal esophagus, making these very important operative steps much easier, safer, and more reliable.

Anastomosis, Surgical↗
PubMed1978

[End-to-side ileo-colonic anastomosis perpendicular to the band (30 cases) (author's transl)].

Over the last 3 years, the authors restore intestinal continuity after ileo-colonic removal by end-to-side anastomosis according to Bloch's technic the colonic incision is made perpendicular to the peritoneal band. This type of anastomosis, in view of the mode of distribution of the colonic arterioles does not cause any loss of blood supply as is sometimes the case on the antemesocolic border of the incision when it is made on the band. The first results appear very encouraging as in the first thirty cases there was only one case of breakdown of sutures in the anastomosis. The latter was not due to the technic but to recutting of the ileum in an area with a poor blood supply.

Aged↗
PubMed2002

Intracardiac ultrasonic suture welding for knotless mitral valve replacement.

OBJECTIVE: The difficulty in tying multiple knots with endoscopic instruments constitutes a technical obstacle to the development of closed-chest valve surgery. The following set of experiments was undertaken to ascertain the in-vivo feasibility of using an intracardiac ultrasonic welding device for knotless suture fixation during mitral valve replacement (MVR). METHODS: Five adult sheep weighing 48-52 kg underwent MVR with a commercially available mechanical prosthesis, using pledgetted interrupted polypropylene sutures. An ultrasonic suture welder designed for intracardiac use was used to adjust suture tension and fuse strands together without knots. Echocardiographic assessment of the mitral prosthesis was carried out at baseline and after maintenance of supraphysiologic arterial pressures for 60 min. Subsequently, the animals' explanted hearts were assessed under sustained left ventricular (LV) pressurization to 180 mmHg in an ex-vivo pressure-loop system. RESULTS: MVR was successfully performed in all animals and welds reliably completed in less than 1 s. One sheep could not successfully be weaned off cardiopulmonary bypass; however, a normal prosthetic valve implant was confirmed at post-mortem examination. Echocardiographic assessment prior to and during LV pressurization revealed normal seating and function of the prosthesis in all cases. At post-mortem examination all valves were adequately implanted, suture tails laid flat on the surface of the prosthesis' sewing ring, welded suture strands were intact and accurately point-fused together, and no evidence of perivalvular leak was found around any of the prostheses despite sustained LV pressurization. CONCLUSIONS: This new modality proved reliable in an acute sheep model of MVR and could constitute a promising avenue towards facilitation of total endoscopic valve procedures in humans.

Animals↗
PubMed1970

[Dermostitch technic].

Explore the source record for details and available documents.

Dermatologic Surgical Procedures↗
PubMed2005

Fibrin glue v sutured bolster: lessons learned during 100 laparoscopic partial nephrectomies.

PURPOSE: Laparoscopic partial nephrectomy (LPN) is performed with marked technical variations. We defined the limits of sutureless LPN and determined which closure technique is best in a particular situation. MATERIALS AND METHODS: During 100 consecutive LPNs fibrin glue products were used for closure in the first 75 (group 1) and sutured bolsters were applied when the collecting system (CS) or renal sinus was entered in the final 25 (group 2). RESULTS: In groups 1 and 2 hand assisted laparoscopy was used in 72% vs 40% of cases and hilar clamping was used in 27% vs 92%, respectively. Mean tumor size was 25 vs 26 mm, tumor depth was 11 vs 13 mm, distance to the renal sinus was 9 vs 5 mm, operating room time was 185 vs 210 minutes, estimated blood loss was 398 vs 247 cc and hospital stay was 2.9 vs 2.6 days in groups 1 and 2, respectively. Overall postoperative hemorrhage and urine leakage occurred in 9% and 2% of patients, respectively. Tumors associated with postoperative hemorrhage/leakage tended to be larger (35 vs 24 mm, p = 0.007) and closer to the renal sinus (0.5 vs 8.2 mm, p = 0.02). Postoperative hemorrhage or urine leakage occurred in 41% of the 17 patients in group 1 with CS or renal sinus entry but in only 2 of the 58 (3.4%) without entry (p <0.0001). In group 2 hemorrhage/leakage occurred in 11% of the 18 patients with CS or renal sinus entry (vs same subset in group 1, p = 0.04). CONCLUSIONS: LPN with closure using fibrin glue products provides adequate hemostasis when the CS or renal sinus is not entered. When the CS or renal sinus is entered, a sutured bolster is recommended.

Decision Trees↗
PubMed1994

[Single-layer anastomosis of the colon].

Presented are the analysis of 134 single-layer colon anastomosis done between years 1983 and 1993. Essential parameters of those are compared with two-layer colon anastomosis - 65, done at the same period, as well as with wider series done in the world in a last couple of years. Main task of the analysis is to point to contemporary developments of suture technique in the world and at home, which is being simplified in technical terms, characterized by time and material savings without affecting anastomosis quality. Those characteristics have been attained due to good preparation of intestines, improved materials, antibiotics and due to finding out that submucosis and subserosis are carriers of suture firmness. On processed material when single-layer suture was used (134) we had average of 8.2% clinically evident fistulas - single-layer individual (78) 3.8% a single-layer continuous (58) 14%. With two-layer suture technique (65) we had 14% clinically evident fistula. Average mortality with both techniques was 4%.

Adult↗
PubMed1992

Ulnar collateral ligament repair of the metacarpo-phalangeal joint of the thumb: a study comparing two methods of repair.

25 patients were assessed following repair of an acutely ruptured ulnar collateral ligament of the thumb metacarpo-phalangeal joint. The patients were divided into two groups, repaired by either a horizontal mattress suture using 4/0 polybutylate (nine patients), or a pre-fashioned steel wire (16 patients). Assessment included a physical examination and functional testing at a mean of 12.9 months (range 4-36 months) after the operation. Both techniques were equally effective, and the use of the more expensive steel wire, while technically satisfying and easy to perform, offers no clinical advantage over simple suture. This pre-fashioned steel wire is, however, recommended in those cases with an avulsion fracture or where distal avulsion of the ligament is associated, since the technique allows easy secure reduction.

Adolescent↗