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At least 1,603 records · Page 89Linked to original sources
PubMed1981

Palliative side-to-side oesophagogastrostomy for unresectable carcinoma of the oesophagus and cardia.

The distressingly low resectability rate of carcinoma of the oesophagus and gastric cardia emphasises the need for palliative restoration of the act of swallowing. Side-to-side oesophagogastrostomy was performed in 10 cases of unresectable tumours. Eight anastomoses were made low in the left chest for lower third oesophageal and cardiac lesions and two high on the right for midoesophageal tumours. There were no anastomotic leaks or other complications, and no postoperative deaths. All patients swallowed well for an average of five months until their deaths. The decision to use this procedure is made at the time of thoracotomy when resection of the cancer is impossible because of local invasion and when sufficient proximal oesophagus is available for the anastomosis. The operation involves a single suture line only. It provides immediate palliation of dysphagia and makes unnecessary additional technical manoeuvres such as preparation of colonic or jejunal loops insertion of endoluminal tubes, or even transection of the oesophagus, pyloroplasty, gastrostomy or cervical oesophagostomy. It does not interfere with any subsequent radiotherapy or chemotherapy.

Adenocarcinoma↗
PubMed1978

Intimal dissection of the superficial temporal artery.

Three patients who underwent superficial temporal-middle cerebral artery anastomosis demonstrated a dissection of the intima of the superficial temporal artery at operation. The fact that this abnormality had not been appreciated previously in surgical series and that it and other anatomical variants may account for "technical failures" of anastomoses is elucidated. The authors describe their successful technique for suturing the intimal flap.

Cerebral Arteries↗
PubMed1995

[Mitral surgery by superior biatrial septotomy].

The superior biatrial septotomy approach consists of two semicircular right atrial and septal incisions joined at the superior end of the interatrial septum and extended across the dome of the left atrium, allowing exposure of the mitral valve by reflecting the ventricular side using stay sutures. From 1991 to 1993, 81 patients underwent mitral valve surgery by this technic. Mitral valve operation was combined with other cardiac procedures in 30 patients (37%) and was performed as a second operation in 21 patients (25.9%). Duration of cardiopulmonary bypass and aortic occlusion was not significantly different from that of patients operated via a conventional left atrial approach. The five hospital deaths (6.2%) were not related to this operative approach. Only 2 patients (3.3%) with preoperative in sinus rythm were discharged in atrial fibrillation after operation. In one patient (1.6%), atrioventricular block appeared at late follow-up. There were no cases of bleeding, atrioventricular nodal dysfunction or intra-atrial shunting related to the approach. This approach provides excellent exposure of the mitral valve even in unfavorable situations such as a small left atrium, dense adhesions from previous procedures or a previously implanted aortic prosthesis, without damage to various cardiac structures due to excessive traction. No retractor or vena cava repair are required. These data support a wide application of the superior biatrial septotomy approach in mitral valve surgery.

Adult↗
PubMed1996

[Postoperative peritonitis].

This is a report on retrospective summed-up analysis of the therapeutic approach to 296 patients presenting postoperative peritonitis (PP). They account for 1.4 per cent of the total number of patients operated on in the clinic. The latter percentage differs in the single groups of patients, distributed by organic localization of the pathological process, as follows: 1.3 per cent in hepatobiliary and pancreatic diseases, and 1.9 per cent in gastroduodenal ones. In colorectal diseases the percentage grows to 8, and after the 80th year of life it falls to and below 4, amounting to 2.2 per cent during the last five years. The overall mortality rate is 69 per cent--57.7 and 72.5 per cent respectively for the three separate groups-mainly at the expense of patients presenting oncological diseases, 73.5 per cent. The underlying causes of PP development comprise: insufficiency of the anastomosis, intraoperative contamination and infection of the abdominal cavity, intraoperative oversights-technical errors, iatrogenic and foreign body, circulation derangement in the organ operated on, suture applied to cancer infiltrated and infected tissue and persisting peritonitis for which the intervention is undertaken. The diagnosis is difficult regardless of the biochemical, instrumental and microbiological examinations performed. Early relaparotomy is the only possible life-salvaging approach to the patient, its immediate goal being sanation of the source, peritoneal lavage, wide drainage and ileostomy. PP remains a problem difficult to handle irrespective of the progress of antibiotic and resuscitation treatment.

Acute Disease↗
PubMed2001

Modified cross-pin femoral fixation using long needles, polydioxanone suture, and traction suture for hamstring anterior cruciate ligament reconstruction.

The use of cross-pin femoral fixation in anterior cruciate ligament (ACL) reconstruction using semitendinosus and gracilis (ST/G) tendons has been shown to be biomechanically sound. As a result of some technical problems that we encountered, we modified the technique of the DePuy OrthoTech Xact ACL Graft Fixation System (DePuy, Warsaw, IN) using No. 2/0 polydioxanone suture (PDS) with long needles normally used for inside-out meniscal repair. In addition, a No. 5 Ethibond suture loop (Ethicon, Somerville, NJ) is used for traction of the ST/G graft up the femoral tunnel. Using a 2-suture loops technique, the traction suture loop offers a more effective in-line pull for the graft and it pulls the ST/G loops slightly higher than the alignment PDS. By so doing, it lessens the chance of kinking the alignment guidewire or even amputating the graft. Although not reported in literature, this type of graft complication is possible in other single-alignment suture or guidewire techniques.

Journal Article↗
PubMed2005

Open guide suture technique for safe microvascular anastomosis.

Despite the evident advances in microsurgery, anastomosis of small vessels or anastomosis of vessels having size discrepancy, remains one of the most precise and technically demanding issues in replantation surgery and free tissue transfer procedure. The patency of the vascular anastomosis is critical and essential for a successful outcome. In this study, a microvascular anastomosing technique called open guide suture technique is introduced. The technique starts with a conventional whole-layer stitch and continues under the control of a guided suture that is inserted but not completed to a knot 180 degrees distant from the initial suture. Recently, we used this technique in 30 free flap transfers and 4 replantation procedures. A total of 103 anastomoses were performed. Only 1 flap, which had both arterial and venous problems, and 1 finger replantation case that had arterial problems required revision. Both the revised cases were salvaged, giving a revision rate of 2.91% for the total number of anastomoses (3 of 103), and a 100% success rate for final flap and replanted part survival. In conclusion, this technique provides a safe anastomosis performed under completely clear visualization at each step with well-arranged knot intervals.

Anastomosis, Surgical↗
PubMed1986

[Mechanical sutures in digestive surgery. A critical study].

An objective review of the experimental and clinical literature comparing stapled- and hand-sutured anastomoses in gastrointestinal surgery is presented. Experimental studies support the hypothesis that stapled-sutured lines heal by primary intention, thus avoiding the inflammatory time lag, and resulting in a stronger wound during the first post-operative week. In contrast, manual sutures always produce an early inflammatory reaction with a transitory rise in collagenase activity in the submucosa, which explains the particular fragility of the anastomosis during that phase. Nevertheless, it was difficult to find a concordance between this histological quality of the stapled suture line and clinical results. In oesophageal surgery, a slightly higher rate of stenosis and a lower rate of anastomotic leakage were observed. In gastric and colorectal surgery, the superiority of the stapled suture was not proved. However, in colorectal randomized studies, the presence of "withdrawn" group for which the stapler was the only technically possible alternative, provides undeniable proof that this technique is an indispensable adjunct in modern digestive surgery. Conversely, its value seems negligible in surgery of the small bowel or of the intraperitoneal colon where manual suturing remains the technique of choice.

Acute-Phase Reaction↗
PubMed2003

Revisiting the surgical creation of volume load by aorto-caval shunt in rats.

Cardiac hypertrophy is an early landmark during the clinical course of heart failure, and is an important risk factor for subsequent morbidity and mortality. The hypertrophy response to different types of cardiac overload is distinguished both at the molecular and cellular levels. These changes have been extensively characterized for pressure load hypertrophy; however, similar information for volume load hypertrophy is still needed. This study was undertaken to improve the existing method of producing experimental cardiac volume load. Previous investigators have employed surgical aorto-caval shunt (ACS) as a model for volume load hypertrophy (VO) in rats. The procedure is relatively simple and involves glue to seal the aortic hole after ACS. However, it has several limitations mostly related to the use of glue e.g. poor visualization due to hardening of tissues, imperfect sealing of the puncture site and glue seeping through the aortic hole resulting in shunt occlusion. We have modified the procedure using aortic adventitial suture instead of glue and 18G angiocatheter instead of 16G needle, which eliminated the technical difficulties from the former method. The ACS was visually confirmed at sacrifice, and the VO demonstrated by time-related changes in the heart weight/body weight ratio which increased from 78% at 4 weeks to 87% at 10 weeks and increased liver/body weight ratio by 22% at 10 weeks of post aorto-caval shunt. Cardiac expression of atrial natriuretic peptide (ANF) also demonstrated time-related increase in ANF mRNA (+275% increase at 4 weeks, p < 0.05, and +370% increase at 10 weeks, p < 0.001). This modified technique of aorto-caval shunt offers simpler, reproducible and consistent model for VO hypertrophy in rats.

Animals↗