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PubMed1987

Reduced anastomotic bleeding using new sutures with a needle-suture diameter ratio of one.

Reduction of blood loss from a vascular anastomosis, especially when one is using a polytetrafluoroethylene (PTFE) graft, is of great interest; even when a technically perfect anastomosis has been performed, there can still be significant and often bothersome bleeding from the needle holes. Currently, sutures have a needle-to-suture ratio of 2:1 or 3:1. Two new sutures, one made of PTFE and the other of polypropylene, were designed to have a needle-to-suture diameter ratio of 1:1. Theoretically, this allows the suture to completely fill the graft needle hole and control bleeding. These sutures were evaluated in a heparin-treated canine in vivo model to measure graft needle-hole bleeding. The materials were also tested by an independent laboratory to compare the basic physical characteristics. Twenty centimeters of 6 mm PTFE graft was interposed in an end-to-end fashion to the infrarenal canine aorta. The graft was then transected at its midpoint and a series of end-to-end, graft-to-graft anastomoses were performed with alternate experimental and control sutures. The experimental PTFE suture bled a mean of 12.46 ml per anastomosis. The experimental polypropylene bled 4.32 ml per anastomosis, while a control suture of polypropelene with a needle-to-suture ratio of 1.94 (5-0 prolene with a C-1 needle), produced a mean blood loss of 33.35 ml per anastomosis. These data are based on a total of 82 anastomoses. The results were analyzed with a two-tailed paired t test. As the data indicate, both experimental sutures allowed significantly less bleeding than the controls (p = .05). The testing of physical properties of the suture included diameter, tensile strength, needle pull-off strength, and elongation percent and were performed by an independent laboratory. These findings are included along with subjective evaluations of the sutures' handling qualities. We believe that sutures produced with needle-to-suture ratios of 1:1 greatly reduce graft needle-hole bleeding and will be a useful addition to the vascular surgeon's armamentarium.

Animals↗
PubMedDate not supplied

Intestinal anastomoses.

Anastomotic dehiscence remains the main cause of morbidity and mortality of intestinal resections, mainly the colorectal (77, 95, 110). Very often in the literature the words dehiscence and fistula are misused for the same meaning. Nevertheless, attention must be paid to the fact that these two situations may be distinct. Dehiscence is defined as the failure of healing of the anastomoses, while fistula is the leakage of the intestinal content into the peritoneal cavity. So, the evidence of fistula is always accompanied by dehiscence, although a dehiscence may not develop into a fistula, should it be blocked by omentum or surrounding organs (110, 117). The incidence of overt dehiscence varies from 0.1% to 30% in the literature (13, 15, 17, 27, 31, 40, 44, 46, 76, 77, 81, 96, 113, 120, 123, 126, 133, 135). The Colon Cancer Project of the Saint Mary's Hospital in London, a multicentric study of patients submitted to bowel resections revealed a post operative mortality of 22% in patients with dehiscence and 7% for uncomplicated anastomoses. This led to the struggle various authors to achieve better results, regarding techniques and suture materials, such as the number of planes involved, inverted or everted sutures, wound healing and the influence of local and systemic factors, like infections, antibiotics, NSAIDs on sutures. Recently, surgical stapling gained importance among surgeons, due to its technical advantages. However, this is still very controversial and must undergo further investigations (93, 107, 109, 112, 115, 116). So, in order to understand the pathophysiology of the complications and to reduce morbidity and mortality, related to intestinal anastomoses, it is necessary to study the events involved in intestinal healing after resection, as well as the technique, materials used and the factors related to anastomotic failure.

Anastomosis, Surgical↗
PubMed2004

The laparoscopic repair of suprapubic ventral hernias.

BACKGROUND: The complexity of dissection and the close proximity of the hernia to bony, vascular, nerve, and urinary structures make the laparoscopic repair of suprapubic hernias (LRSPH) a formidable operation. We performed a prospective evaluation of the outcomes of patients undergoing LRSPH. METHODS: The study population comprised 36 patients undergoing LRSPH from July 1996 to January 2004. Patient demographics, hernia sizes, mesh types and sizes, perioperative outcomes, and recurrences were documented. After our early experience with this operation, the repair evolved to include transabdominal suture fixation to the pubic bone, Cooper's ligament, and above the iliopubic tract. RESULTS: There were 26 women and 10 men. They had a mean age of 55.9 years (range, 33-76) and a mean body mass index (BMI) of 31.0 kg/m2 (range, 22-67). Twenty-two (61%) of the repairs were for recurrent hernias, with an average of 2.3 previously failed open repairs each (range, 1-11). The mean hernia size was 191.4 cm2 (range, 20-768), and the average mesh size was 481.4 cm2 (range, 193-1,428). All repairs were performed with expanded polytetrafluoroethylene (ePTFE) mesh. Mean operating time was 178.7 min (range, 95-290). Mean blood loss was 40 cc (range, 20-100). One patient undergoing her fifth repair required conversion due to adhesions to a polypropylene mesh. Hospital stay averaged 2.4 days (range, 1-7). Mean follow-up was 21.1 months (range, 1-70). Complications (16.6%) included deep venous thrombosis (n = 1), prolonged pain for >6 weeks (n = 1), trocar site cellulitis (n = 1), ileus (n = 1), prolonged seroma (n = 1), and Clostridium difficile colitis (n = 1). Hernias recurred in two of our first nine patients, for an overall recurrence rate of 5.5%. Since we began using the technique of applying multiple sutures directly to the pubis and Cooper's ligament (in the subsequent 27 patients), no recurrences have been documented. CONCLUSIONS: Although technically demanding and time-consuming, the LRSPH is safe and technically feasible. Moreover, it results in a low recurrence rate and is applicable to large or multiply recurrent hernias. Transabdominal suture fixation to the bony and ligamentous structures produces a more durable hernia repair.

Adult↗
PubMed1986

New upper and lower clamps for use in anterior resection of the rectum by hand suture or stapling techniques.

New occlusive clamps have been designed to facilitate anterior resection of the rectum. A T shaped upper occlusive clamp with centrally placed arms, curved transverse end and its total length and light weight provide more secure control of the intestine and allows the surgeon a less obstructed view of the distal site of section than the traditional L shaped rectal clamps. A lower occlusive clamp has been designed to obviate many of the inherent problems of controlling and suturing a rectal stump in the depths of the pelvis. Main concerns and technical troubles are retraction of the stump, loss of control of the flabby rectal remnant and difficulty handling the anterior and posterior walls as the surgeon attempts to make the anastomosis. The lower clamp keeps the rectum from retracting and the proximal cut end is held open by four stay sutures to wings on the right and left blades of the clamp. It is used to facilitate the placement of a purse-string suture in the EEA stapling technique or in a hand sutured anastomosis.

Humans↗
PubMed1989

[Cardiomyoplasty. Experimental bases, operative technic, indications].

Dynamic cardiomyoplasty aims at restoring ventricular contractility by means of a skeletal muscle sutured around the heart. It consists of transferring a latissimus dorsi muscle flap onto the heart through a window created in the thoracic wall by partial resection of the second rib. The skeletal muscle may be used to reinforce the ventricular systole in ischemic or dilated cardiomyopathy, or to replace the myocardium after resection of a large aneurysm or an extensive tumour. The electronic pacing material includes an implantable cardiomyostimulator, muscle stimulating electrodes and R wave detecting electrodes. Muscular pacing begins 2 weeks after the operation, this being the time required for adhesions to be formed between the heart and the muscle. A progressive and sequential electrostimulation procedure results in the transformation of glycolytic muscle fibres that are fatigue-sensitive into fatigue-resistant oxidative fibres. The purpose of this biomechanical cardiac assistance system, where cardiac surgery is combined with plastic surgery and biomedical engineering, is to prolong life and improve its quality in patients with severe heart failure.

Assisted Circulation↗
PubMed2006

Reduction of face and neck laxity with anchored, barbed polypropylene sutures (Contour Threads).

The use of nonabsorbable sutures for lifting lax, aging skin is an increasingly popular option for cosmetic surgeons. Contour Thread (Surgical Specialties Corp.) are novel modified polypropylene sutures recently approved for this purpose by the US FDA. Design and technical modifications incorporated into this implant may reduce complications and limitations seen with previous, similar products. Early experience has been positive, although the durability of cosmetic effect and the potential for long-term complications remain to be seen.

Absorbable Implants↗
PubMed2006

Venous thrombosis in coupled versus sutured microvascular anastomoses.

BACKGROUND: The anastomotic coupling device (ACD) is currently used for microsurgical venous anastomoses as an alternative to sutures and can reduce anastomotic time. METHODS: We reviewed the microsurgical procedures performed at the University of Texas M. D. Anderson Cancer Center over a 40-month period. Procedures were performed for elective reconstruction of the breast, head or neck, or extremities after tumor excision. Thrombosis and ultimate flap salvage rates were compared between cases using ACDs and those using sutures for the venous anastomoses. RESULTS: Seven hundred twenty-three free flaps were included in the study. There were no intraoperative technical complications using the ACD. Overall, the venous thrombosis rates were not significantly different between the ACD (1.4%, 2/139 cases) and sutured (3.3%, 19/584 cases) groups. Salvage rates following venous thrombosis were not significantly different for venous anastomoses performed with an ACD (50%, 1 of 2 cases salvaged) compared with venous anastomoses performed with sutures (68.4%, 13 of 19 cases salvaged). CONCLUSION: The ACD is a useful alternative to sutured venous anastomoses that can reduce anastomotic time while achieving similar patency rates.

Anastomosis, Surgical↗
PubMed1992

[Initial experiences with the bio-fragmentable Valtrac anastomosis ring].

The biofragmentable ring (Valtrac) to perform a sutureless bowel anastomosis was used in a short period until complications rate became to big. There were six ileo-colostomies with the 28 mm ring and 7 colo-colostomies with the 31 mm ring. In 4 patients additional sutures were placed because the ring was shining through the tissue. Thirteen patients (4 women, 9 men) with a mean age of 63 years (36-78) were included. Complications occurred in 3 men (71, 36 and 63 years old). Two of them had an additional suturing. One demonstrated insufficiency at day four with many small gabs in the anastomotic line according to the ring design. Histology demonstrated perfect microcirculation. The second patient developed a fistula three weeks after operation. Both had an ileo-colostomy. The third operated because of a gastrocolic fistula with cachexia reentered hospital seven weeks postoperatively with a new gastrocolic fistula on X-ray. He died with a cardiac arrest. Postmortem was refused. We conclude from our results that the Valtrac ring should be used only by experienced surgeons, there is no reduction in operation time, and ileo-colostomy needs special care. We believe that surgeons using an extramucosal monofilament running suture for colonic anastomosis are more unlikely to switch to the Valtrac ring than those using other technics.

Adult↗
PubMed2002

Laparoscopic live donor right nephrectomy: a new technique with preservation of vascular length.

PURPOSE: We report our initial experience with right laparoscopic live donor nephrectomy using a modified vascular clamp for achieving maximal length of the renal vein. MATERIALS AND METHODS: Since 1999, 34 patients have undergone laparoscopic live donor nephrectomy at Charité Hospital in Berlin, including 30 on the left and 4 on the right side. The right technique involves a 4-port transperitoneal laparoscopic approach with a muscle splitting lumbar incision for kidney extraction. To duplicate completely the comparable open operation a modified Satinsky atraumatic vascular clamp (Aesculap, Inc., Center Valley, Pennsylvania) was introduced through a 1 cm. lateral incision and placed across the vena cava, enabling harvest of the full length of the renal vein flush with the vena cava. The vena cavotomy is closed with a running suture placed in intracorporeal fashion. RESULTS: All procedures were successfully accomplished without technical or surgical complications. Mean operative time was 170 minutes. Mean renal warm ischemia time from endoscopic cross clamping of the renal vessels to cold perfusion on the bench was 2.1 minutes. In all 4 kidneys it was possible to harvest the whole length of the renal vein, so that the recipient operation was performed under optimal vascular conditions. All 4 kidneys were transplanted successfully in the recipients and showed immediate function. CONCLUSIONS: Right laparoscopic live donor nephrectomy is technically feasible, safe and a viable option for minimally invasive organ donation when left kidney donation is not desired. The Satinsky atraumatic vascular clamp enabled harvest of the whole right renal vein. We believe that this laparoscopic technique effectively duplicates the open operation with less morbidity.

Adult↗
PubMed1981

[Second generation of absorbable suture material. Tissue reaction and indication (author's transl)].

Polyglycolic acid (PGA) sutures have proved to be superior than other, nonabsorbable suture materials: a higher traction capacity and knot-tearing security, a defined and nearly linear decrease of traction capacity, no immunological reactions, very little capillarity, minimal tissue reaction, nearly no scar formation, and a bactericidal effect. PGA sutures of the second generation have the same advantages, but surgical handling is so much improved that they may be technically employed in unfavorable locations. In the surgery of gastrointestinal tract and respiratory organs there is a trend to connect all layers with one suture.

Absorption↗
PubMed1977

Recurrent aortoduodenal fistula.

We describe the second successful repair of a recurrent aortoduodenal fistula (ADF) occurring two years following insertion of the original prosthetic and 18 months following the repair of the first ADF. The recurrent ADF developed at the site of the previous repair, fistulizing between the sutured aorta and the duodenum closed by staples. Despite the admitted technical challenges of reoperation for a third or fourth time, as in the current case, these patients can be salvaged.

Aorta, Abdominal↗