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At least 1,585 records · Page 88Linked to original sources
PubMed2002

Percutaneous endopyeloplasty: a novel technique.

BACKGROUND AND PURPOSE: Despite a 10% to 15% failure rate, endopyelotomy remains the treatment of choice for most patients with ureteropelvic junction (UPJ) obstruction. We present a novel technique of percutaneous endopyeloplasty, wherein a precise, full-thickness approximation of a standard longitudinal endopyelotomy incision is performed in a horizontal Heineke-Mikulicz fashion through the conventional solitary percutaneous tract via a nephroscope. We assess the feasibility and efficacy of percutaneous endopyeloplasty in a chronic porcine bilateral UPJ obstruction model and compare outcome data with those#10; of conventional endopyelotomy and laparoscopic pyeloplasty. MATERIALS AND METHODS: Partial UPJ obstruction was created in 20 kidneys (11 pigs) by laparoscopic ligation of the upper ureter over a 5F ureteral catheter. After development of hydronephrosis over a period of 4 to 6 weeks, percutaneous endopyeloplasty (N = 10), conventional percutaneous endopyelotomy (N = 5), or laparoscopic pyeloplasty (N = 5) was performed. The essential steps of percutaneous endopyeloplasty include retrograde ureteral catheterization, standard percutaneous endopyelotomy incision, mobilization of the distal ureteral lip, horizontal suturing of the endopyelotomy incision through the nephroscope, and nephrostomy drainage and ureteral stenting. Suturing was performed using a modified 5-mm laparoscopic device (Sew Right 5 SR; LSI Solutions, Rochester, NY), which was passed through the nephroscope. RESULTS: Percutaneous endopyeloplasty was technically successful in all 10 kidneys with a mean total operative time of 81.4 minutes (range 51-117 minutes). The mean endopyeloplasty suturing time was 29.4 minutes (range 20-64 minutes). Three kidneys required two sutures, while seven kidneys required three sutures to complete the endopyeloplasty. The solitary complication was a lower-pole infundibular stenosis. Over a mean follow-up of 7.7 weeks, all renal units showed relief of obstruction, as evidenced by regression of hydronephrosis,#10; improvement in T(1/2) and glomerular filtration rate on renogram, and a low intrapelvic pressure on Whitaker test. At autopsy, the endopyeloplasty site showed a fine, well-healed transverse scar with no evidence of residual suture on the mucosal surface. The mean caliber of the UPJ following endopyeloplasty (13.8F +/- 2.2F) was significantly greater (P = 0.01) than that following endopyelotomy (7.5F +/- 1.9F). Intraoperative extravasation on completion of endopyeloplasty was absent (N = 6) or mild (N = 4) compared with that seen in all five kidneys following endopyelotomy. CONCLUSION: Percutaneous endopyeloplasty is feasible, simple, reproducible, and effective. Its advantages over conventional endopyelotomy include transrenal performance of a Fenger-plasty, wider caliber of the UPJ, absence of extravasation, and shorter duration of ureteral stenting.

Animals↗
PubMed2005

Stapled haemorrhoidectomy: bothersome staple line bleeding.

BACKGROUND: The stapled haemorrhoidectomy procedure has been popularized as a painless and effective treatment for prolapsing haemorrhoidal disease. We have noted that staple line bleeding is a contributory factor to postoperative morbidity. METHODS: This was a retrospective analysis of the clinical records of consecutive stapled haemorrhoidectomy procedures performed in patients over a 1-year period. The outpatient, operative and inpatient records were reviewed. We assessed the incidence of intraoperative staple line bleeding, its management and early postoperative outcomes in our patients undergoing stapled haemorrhoidectomy. RESULTS: From March 2000 to March 2001, 39 stapled haemorrhoidectomy procedures were performed. Intraoperative staple line bleeding was recorded in 17 patients (44%) and suture reinforcement of this staple line was required in 12 (31%). Nine patients (23%) were admitted for postoperative per rectal bleeding, four of whom required surgical haemostasis of bleeding points along the staple line. Delayed secondary haemorrhage was seen in one patient. The incidence of postoperative bleeding in patients with noted staple line bleeding was 35%, compared with 14% in those without evidence of bleeding. CONCLUSION: Staple line bleeding is a technical difficulty and complication associated with stapled haemorrhoidectomy. It should be managed with meticulous haemostatic suture placement in order to avoid postoperative bleeding and the morbidity of re-operation for haemostasis.

Adult↗
PubMed2000

Nonpenetrating vascular clips for small-caliber anastomosis.

In the search for better anastomosing techniques, an improved vascular stapler device (VCS clip applier system(R)) has been introduced. The system uses nonpenetrating clips to approximate everted vessel walls. The objective of this study was to determine the effects of nonpenetrating vascular clips on endothelial wound healing. Aortic end-to-end anastomoses were performed in male Wistar rats. A comparison was made between clipped (n = 12) and conventional hand-sewn (n = 6) anastomoses. Patency rates were verified at different time intervals (after 1, 4, and 8 weeks), after which the anastomotic sites were removed. Morphological evaluation was carried out using scanning electron microscopy. All rats survived the procedure. Closure with clips took less time than closure with conventional sutures, with decreasing aortic clamping times for the clipped procedures during the course of the experiments. Patency rates were 100% in both the "clipped" and "sutured" groups. Microscopic examination showed favorable endothelial healing at the clipped anastomotic sites, with less inflammatory reaction at 1 week, and a more complete endothelial regeneration at 4 and 8 weeks follow-up, as compared with the sutured anastomoses. The clip applier holds the promise of a useful device in anastomosing small-caliber vessels, since clip closure takes less time than suturing, while patency rates are identical, and morphological results are favorable. Training is mandatory to obtain technical skills and to achieve optimal results.

Anastomosis, Surgical↗
PubMedDate not supplied

Testicular fixation in adult retractile testis: technical notes.

A variety of techniques for scrotal orchiopexy have been described in the literature, including those without suture fixation, such as the scrotal pouch. We perform a simple modified technique for bilateral testicular fixation in patients with bilateral and/or unilateral adult retractile testis and with symptoms characterised by chronic orchialgia due to testicular hypermobility or repeated funicular subtorsion.

Adolescent↗
PubMed1978

[Distal fixation of the intima after endarterectomy. Technical variation].

Oblique termination in a "bevel" of the distal endartery and its fixation by a circumferential continuous suture which provides a surface which is as stable and regular as possible, after endarterectomy. This may favourise improuved distal flow and influence immediate and late local permeability.

Arteries↗
PubMedDate not supplied

Small bowel and colon transplantation in rats using porto-portal cuff anastomosis.

Portal versus systemic venous drainage and colon grafting are major controversies in the techniques of intestinal transplantation. The rat is the best animal for research in this field. Nevertheless, this model requires complex microvascular anastomoses that are responsible for the high incidence of technical failures. A cuff technique is an easier anastomosis method than a hand-suture. We describe a simplified rat model of small bowel and colon transplantation using a porto-portal cuff anastomosis. DONOR: The entire small bowel, cecum, and ascending colon are harvested on a vascular pedicle, consisting of a long aortomesenteric conduit and portal vein. The right colonic vessels are preserved. The graft is flushed and a cuff device is placed on the end of the portal vein. RECIPIENT: The graft is implanted through an end-to-side aorto-aorta hand-sewn anastomosis. A segment between the first and second jejunal branch is isolated between clamps to insert into the portal cuff. After reperfusion, the recipient's mesentery is divided just below the cuff anastomosis. The recipient jejunum, ileum, and ascending colon are removed en bloc, and the graft is anastomosed in continuity with the remaining naive intestine concluding the operation. This simplified technique surmounts the technical obstacles in rats because it is easily and quickly performed, maintaining the physiological portal drainage, preserving graft ileocecal valve and ascending colon, and reaching acceptable success after a short period of training.

Anastomosis, Surgical↗
PubMed1976

The new look into the gastrointestinal tract.

Esophagogastroduodenoscopy has proved to be the most accurate method of diagnosing disese of the upper gastrointestinal tract. Endoscopic technics already are being employed for the treatment of gastric polyps. Experimental work on endoscopic treatment of upper gastrointestinal bleeding is under way in several medical centers. A variety of methods are being tested: laser photocoagulation, suture clip placement and the use of bioco+mpatible tissue glues. Endoscopic retrograde cholangiopancreatography now is established as a useful technic in the diagnosis of biliary tract disease. Its diagnostic usefulness in the pancreas is confined to certain diseases in which it is desirable to determine the need for operative intervention. The initial success of endoscopic papillotomy and stone extraction promises further future therapeutic uses for ERCP. Colonoscopy may well prove to be the most useful of the gastrointestinal endoscopic methods. It is particularly helpful in diagnosing colonic cancer, in determining the source of occult colonic bleeding and in providing information regarding idiopathic colonic inflammatory disease. The success of polypectomy indicates the possibility of substituting endoscopic treatment for invasive surgery. Laparoscopy in conscious patients is a well-established technic that is useful in gastroenterology, hepatology, oncology and gynecology. Its usefulness has long been appreciated in other countries and the method merits wide use in the United States. Endoscopy is a rapidly changing and evolving field. This monograph has attempted to outline the current state of the art, but many changes are expected in the next 5-10 years.

Biliary Tract Diseases↗
PubMed1978

[Breakdown of the anastomosis after colectomy. The causes and prevention (author's transl)].

Over a period of 3 years the authors have carried out 184 colectomies with immediate restoration of continuity. In 25 of these operated patients the sutures broke down, i.e. 13.5% and 8 died, i.e. one patient out of 3. In the light of this series, the authors studied factors favouring breakdown, whether relative to the patient (age, sex, pathology, nature of the lesion) or the technic followed, i.e. in fact the surgeon (extent of the colonic resection, type and mode of anastomosis, modes of suture and drainage). Were studied also, in prevention, the first or contemporaneous construction of a colostomy, which according to the authors totally prevents breakdown of the subjacent anastomosis, but has its own complications.

Age Factors↗
PubMed1985

Prevention of prosthetic disc immobilization by prolapsed sutures.

Disc immobilization by prolapsed sutures is a rare but potential risk after prosthetic heart valve replacement. We present here a simple technical modification used during prosthetic valve insertion, which can prevent the occurrence of such a complication.

Aortic Valve↗
PubMed1987

[Manual suture versus/or mechanical suture from the German viewpoint].

There is a definite increase in the application of stapled sutures in the gastrointestinal tract and the lung. This is due to high level of technical perfection of modern staplers whose preceding models were actually already developed at the beginning of this century. The introduction of circular staplers since approx. 1978/79 has resulted in a true breakthrough for gastrointestinal tract surgery. Thanks to these circular staplers surgeons have been especially innovative regarding the principles of reconstruction. Thus the procedures for the formation of substitute stomachs (Roux-Y and pouch, interposition and pouch) allow an unprecedented degree of standardization and offer new physiological perspectives. The use of circular staplers in the rectum is generally accepted. However, a recent development concerning manual sutures using medium-term absorbable suture material should not be disregarded.

Gastrointestinal Diseases↗
PubMed1975

[Multilayer dermatoplasty by means of autodermal strip in inguinal hernia].

The author suggests the method of plastic reconstruction of the posterior wall of the inguinal canal by means of an autodermal strip, the lower edges of the internal oblique and transverse abdominal muscle together with the transverse fascia being laced by an autodermal strip. Then, stitches of the latter are sutured to the ilio-pubic band posterior to the testicular cord with a simultaneous constriction of the inguinal canal deep ring. A medial aponeurotic leaf of the external oblique abdominal muscle is sutured to the inguinal ligament anterior to the testicular cord, while a lateral aponeurotic leaf of the former muscle is sutured to the medial one as a duplicature. Since 1971 eighty eight operations have been performed after the technic described. Late results up to 3 years were followed up in 80 cases. No recurrences were noted.

Adolescent↗
PubMed2000

[Orientation aids in biopsy specimens].

Histological findings as regards localizing a lesion suspected to be a tumor and its relation to the margins of a surgical specimen have to be as precise as possible and beyond all doubt. We report on our experience with two technical tools which are especially helpful in excisions of breast tissue: 1) Radiopaque suture material fixed intraoperatively simplifies the correlation of postoperative mammography, X-ray findings with biopsy specimens. 2) AgNO(3), as a solution or in stick form, is faster than ink or other dyes, in marking the margins in small or large surgical specimens because virtually no drying is required.

Biopsy↗
PubMed2006

The accessory posteromedial portal revisited: utility for arthroscopic rotator cuff repair.

Arthroscopic rotator cuff repair is a technically challenging procedure. Accessory arthroscopic portals have been described that allow for optimal suture anchor placement, suture management, and knot tying. We describe here the usefulness of an accessory posteromedial portal that facilitates direct suture retrieval through the posterior aspect of a rotator cuff tear. This portal is created approximately 4 to 5 cm medial to the posterolateral corner of the acromion and 2 cm inferior to the scapular spine. The accessory posteromedial portal is especially useful when a retracted tear of the infraspinatus or teres minor is encountered. Because these tendons retract in a posterior and medial direction, the accessory posteromedial portal places the tendon-penetrating device in an ideal position for suture passage through the posterior portion of the rotator cuff tear. This portal also allows placement of margin convergence sutures for large U-shaped or L-shaped tears by permitting a direct "hand-off" of the suture to or from a second penetrating device that is placed through a standard anterior portal. If multiple suture anchors are required (as in the case of large or massive cuff tears, or when double-row fixation is employed), sutures can be pulled out through the accessory posteromedial portal to facilitate suture management.

Arthroscopy↗
PubMed2000

Initial results with a stapled gastrojejunostomy for the laparoscopic isolated roux-en-Y gastric bypass.

BACKGROUND: The gastric pouch to jejunum anastomosis is a critical step in the performance of an isolated Roux-en-Y gastric bypass. When performing this procedure laparoscopically, intracorporeal suturing of the gastric pouch to Roux-en-Y jejunum anastomosis is technically demanding, time consuming, and perhaps the most prohibitive part of the operation. We devised a unique, effective, and simple method to perform this anastomosis using an EEA stapler. This report describes this technique and its follow-up in our series of patients undergoing a laparoscopic isolated Roux-en-Y gastric bypass utilizing this technique. METHODS: A prospective analysis was performed identifying the technical success, leak rate, and postoperative incidence of anastomotic stenosis and its management in a consecutive series of patients undergoing a laparoscopic isolated Roux-en-Y gastric bypass with a gastrojejunal anastomosis constructed with a 21-mm or 25-mm EEA stapler. RESULTS: Forty-eight patients underwent laparoscopic isolated Roux-en-Y gastric bypass. Mean age was 40.9 years (range 22 to 64) and mean body mass index was 52.3 kg/m(2) (range 31 to 76 kg/m(2)). There were no mortalities. Three patients (6.3%) were converted to an open procedure, but only 1 because of an inability to perform the gastrojejunal anastomosis (short jejunal mesentery). There was 1 leak (2.1%) from the gastrojejunal anastomosis. It was successfully managed nonoperatively. Thirteen patients (27.1%) patients developed an anastomotic stenosis requiring endoscopic balloon dilatation. Seven of the 13 patients required only a single dilatation and have had no recurrence of dysphagia. Six of the 13 patients needed 2 to 4 dilatations, and all are swallowing normally. None have required surgical revision. After 12 months of follow-up, the mean weight loss was 115 pounds and mean decrease in body mass index was 18.5 kg/m(2). CONCLUSIONS: The stapled EEA gastrojejunal anastomosis for the laparoscopic isolated Roux-en-Y gastric bypass is safe and effective. Anastomotic stenosis occurs in approximately one quarter of patients, but it can be managed well with endoscopic balloon dilatation.

Adult↗
PubMed1979

Biomechanical evaluation of metacarpophalangeal joint prosthesis designs.

A laboratory biomechanical analysis of metacarpophalangeal joint prosthesis designs was done with fresh cadaver finger rays. The center of rotation, range of motion, tendon excursion, and fingertip force were determined on the specimens before and after implanting Swanson, Niebauer, Steffee II, St. Georg-Buchholz, Schultz, and modified Strickland prostheses. Their biomechanical behavior varied considerably and none duplicated the normal metacarpophalangeal (MP) joint. Each has design characteristics that may be clinically advantageous as well as disadvantageous. Irrespective of the design, the studies done cannot be divorced from the following factors: (1) implant material properties--silicone rubber implants buckled with tendon loading; this deformity created a significant flexor mechanical advantage and an extensor mechanical disadvantage; (2) implant fixation--freely movable implant stems dampened part of the applied load; braided suture provided inadequate immediate fixation; (3) implantation technique--the articulated prostheses can be technically unforgiving; errors in technique resulted in alteration of their biomechanical behavior.

Biomechanical Phenomena↗
PubMed2003

Modified free paraumbilical perforator flap: the next logical step in breast reconstruction.

The free paraumbilical perforator flap that was developed with only the perforator penetrating the rectus abdominis muscle seems nearly ideal from the donor-site perspective, because it reduces morbidity virtually to that of an abdominoplasty. However, it requires "supermicrosurgery" skills for suturing of vessels with diameters of 0.7 mm or less, making the procedure technically demanding and risky. Another significant disadvantage of that technique is that the flap has very short vascular pedicles. To overcome the disadvantages of the free paraumbilical perforator flap, a minor modification in flap harvesting that improves the vessel size and length is described. Results for a total of 15 patients who underwent breast reconstruction with modified free paraumbilical perforator flaps are presented, and the advantages and disadvantages of this flap are discussed.

Adult↗