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Zhang Y, Cao J, Lu M, Shao Y, Jiang K, Yang X, Xiong X, Wang S, Chu C, Xue F, Ye Y, Bai J. A biodegradable magnesium surgical staple for colonic anastomosis: In vitro and in vivo evaluation. Bioact Mater 2022; 22:225-238. [PMID: 36254273 PMCID: PMC9550537 DOI: 10.1016/j.bioactmat.2022.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 09/03/2022] [Accepted: 09/21/2022] [Indexed: 10/27/2022] Open
Abstract
Staplers have been widely used in the clinical treatment of gastrointestinal reconstruction. However, the current titanium (Ti) staple will remain in the human body permanently, resulting in some adverse effects. In this study, we developed a type of biodegradable staple for colonic anastomosis using 0.3 mm diameter magnesium (Mg) alloy wires. The wire surface was modified by micro-arc oxidation treatment (MAO) and then coated with poly-l-lactic acid (PLLA) to achieve a moderate degradation rate matching the tissue healing process. The results of tensile tests on isolated porcine colon tissue anastomosed by Mg and Ti staples showed that the anastomotic property of Mg staples was almost equal to that of Ti staples. The in vitro degradation tests indicated the dual-layer coating effectively enhanced the corrosion resistance and maintained the tensile force of the coated staple stable after 14-day immersion in the simulated colonic fluid (SCF). Furthermore, 24 beagle dogs were employed to conduct a comparison experiment using Mg-based and clinical Ti staples for 90-day implantation by ent-to-side anastomosis of the colon. The integrated structure of Mg-based staples was observed after 7 days and completely degraded after 90 days. All animals did not have anastomotic leakage and stenosis, and 12 dogs with Mg-based staples fully recovered after 90 days without differences in visceral ion levels and other side effects. The favorable performance makes this Mg-based anastomotic staple an ideal candidate for colon reconstruction.
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Affiliation(s)
- Yue Zhang
- Jiangsu Key Laboratory for Advanced Metallic Materials, School of Materials Science and Engineering, Southeast University, Nanjing, 211189, China,Institute of Biomedical Devices (Suzhou), Southeast University, Suzhou, 215163, China
| | - Jian Cao
- Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing, 100044, China
| | - Mengmeng Lu
- Department of Oral Implantology, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Yi Shao
- Jiangsu Key Laboratory for Advanced Metallic Materials, School of Materials Science and Engineering, Southeast University, Nanjing, 211189, China,Institute of Biomedical Devices (Suzhou), Southeast University, Suzhou, 215163, China
| | - Kewei Jiang
- Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing, 100044, China
| | - Xiaodong Yang
- Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing, 100044, China
| | - Xiaoyu Xiong
- Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing, 100044, China
| | - Shan Wang
- Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing, 100044, China
| | - Chenglin Chu
- Jiangsu Key Laboratory for Advanced Metallic Materials, School of Materials Science and Engineering, Southeast University, Nanjing, 211189, China
| | - Feng Xue
- Jiangsu Key Laboratory for Advanced Metallic Materials, School of Materials Science and Engineering, Southeast University, Nanjing, 211189, China,Institute of Biomedical Devices (Suzhou), Southeast University, Suzhou, 215163, China
| | - Yingjiang Ye
- Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing, 100044, China,Corresponding author.
| | - Jing Bai
- Jiangsu Key Laboratory for Advanced Metallic Materials, School of Materials Science and Engineering, Southeast University, Nanjing, 211189, China,Institute of Biomedical Devices (Suzhou), Southeast University, Suzhou, 215163, China,Jiangsu Key Laboratory for Light Metal Alloys, Nanjing, 211212, China,Corresponding author. Jiangsu Key Laboratory for Advanced Metallic Materials, School of Materials Science and Engineering, Southeast University, Nanjing, 211189, China.
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Eberspacher C, Magliocca FM, Pontone S, Mascagni P, Fralleone L, Gallo G, Mascagni D. Stapled Hemorrhoidopexy: "Mucosectomy or Not Only Mucosectomy, This Is the Problem". Front Surg 2021; 8:655257. [PMID: 33791335 PMCID: PMC8006379 DOI: 10.3389/fsurg.2021.655257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 02/13/2021] [Indexed: 12/31/2022] Open
Abstract
Introduction: Stapled hemorrhoidopexy was originally defined as a rectal mucosectomy. The aims of our retrospective, single-center study were to demonstrate if the excised specimen comprises only the mucosa or more wall rectal layers and if the latter excision should be considered a technical mistake with an increase in complications. Materials and Methods: We histopathologically analyzed surgical samples from patients who underwent stapled hemorrhoidopexy performed between 2014 and 2019. Patients were divided into three groups, according to the stapler used: Group A (single PPH®), Group B (double PPH®), and Group C (CPH34 HV™). We evaluated the actual wall layers included in the stapled rectal ring. For every specimen, we reconstructed the history of the corresponding patient and the incidence of complications. Results: Of the 137 histological slides available, 13 were only mucosectomies (9.5%), and 124 presented also the submucosa and muscularis propria (90.5%)−50/58 patients in Group A, 28/28 in Group B, and 46/51 in Group C. No statistically significant difference in the rate of complications was found when stratifying patients according to the thickness of the resection [mucosectomy (M) or “full thickness” (FT)]. Discussion: Stapled hemorrhoidopexy is not a simple mucosectomy but a resection of the rectal wall with almost all its layers. This concept defines the entity of the surgical procedure and excludes a direct correlation with an increased rate of complications.
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Affiliation(s)
- Chiara Eberspacher
- Department of Surgical Sciences, University of Rome 'Sapienza', Rome, Italy
| | - Fabio M Magliocca
- Department of Radiological Sciences, Oncology, and Pathological Anatomy, University of Rome 'Sapienza', Rome, Italy
| | - Stefano Pontone
- Department of Surgical Sciences, University of Rome 'Sapienza', Rome, Italy
| | - Pietro Mascagni
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Lisa Fralleone
- Department of Surgical Sciences, University of Rome 'Sapienza', Rome, Italy
| | - Gaetano Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - Domenico Mascagni
- Department of Surgical Sciences, University of Rome 'Sapienza', Rome, Italy
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Abstract
A systematic review addressing reported complications of stapled hemorrhoidopexy was conducted. Articles were identified via searching OVID and MEDLINE between July 2011 and October 2013. Limitations were placed on the search criteria with articles published from 1998 to 2013 being included in this review. No language restrictions were placed on the search, however foreign language articles were not translated. Two reviewers independently screened the abstracts for relevance and their suitability for inclusion. Data extraction was conducted by both reviewers and entered and analyzed in Microsoft Excel. The search identified 784 articles and 78 of these were suitable for inclusion in the review. A total of 14,232 patients underwent a stapled hemorrhoidopexy in this review. Overall complication rates of stapled hemorrhoidopexy ranged from 3.3%-81% with 5 mortalities documented. Early and late complications were defined individually with overall data suggesting that early complications ranged from 2.3%-58.9% and late complications ranged from 2.5%-80%. Complications unique to the procedure were identified and rates recorded. Both early and late complications unique to stapled hemorrhoidopexy were identified and assessed.
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Abstract
BACKGROUND Hemorrhoid operations are performed frequently in Germany. After the operation severe complications can occur that require appropriate management. OBJECTIVE Presentation of current complications and suitable therapeutic options. MATERIAL AND METHODS Data including operative procedures and complications that have been collected in an electronic online-based survey of all resident, affiliated and private practice German surgeons during the period from 1 December 2009 to 31 January 2010 are presented. A review of the current literature in a PubMed search is given. RESULTS Stapled hemorrhoidopexy has several benefits during the early postoperative phase in comparison to conventional hemorrhoidectomy; however, patients should be informed about the possibility of postoperative defecation disorders, elevated recurrence and reoperation rates and rare life-threatening complications. CONCLUSION The aim should be to keep risks at a low level by means of prevention, patient selection, careful analysis of indications and relevant expertise. In cases of complications early recognition and direct initiation of adequate treatment are crucial.
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Asteria CR, Robert-Yap J, Zufferey G, Colpani F, Pascariello A, Lucchini G, Roche B. Tailored therapy for different presentations of chronic pain after stapled hemorrhoidopexy. Tech Coloproctol 2016; 20:299-307. [DOI: 10.1007/s10151-016-1458-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 07/11/2015] [Indexed: 01/01/2023]
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Menconi C, Fabiani B, Giani I, Martellucci J, Toniolo G, Naldini G. Persistent anal and pelvic floor pain after PPH and STARR: surgical management of the fixed scar staple line. Int J Colorectal Dis 2016; 31:41-4. [PMID: 26248794 DOI: 10.1007/s00384-015-2355-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Persistent anal pain (PAP) after stapled procedures, be it hemorrhoidopexy (PPH) or stapled transanal rectal resection (STARR) may be hardly resolved by medical therapy. The typical objective finding in these patients is the staple line characterized by fixed scar to underlying layers. METHODS A total of 21 consecutive patients were operated for PAP after stapled procedure. The scarred staple line was excised and detached from layers below, the mucosal continuity reconstructed by single stitches. From January 2003 to December 2013 1500 patients underwent stapled procedure. Of these patients treated in our unit, 9 (0.6 %) were operated for chronic anal pain and 12 were referred to our center from other hospitals. RESULTS Fifteen (71.4 %) patients resolved and do not take any drugs for pain; an overall of 85.7 % (18/21) improved their clinical status. Mean time between the beginning of symptoms and the operation was 4.27 months (range 1-18 months). We divided the patients into three groups: before 3 months, between 3 and 6 months and after 6 months from the beginning of symptoms to the operation. The best results were in the first group with 100 % pain relief and satisfactory functional results. CONCLUSIONS The relief of PAP after stapled procedure, in which we recognize a scarred and fixed staple line, depends by the early recognition of this typical finding. The authors suggest the surgical treatment not later than 3-6 months after the onset of symptoms to achieve the best results.
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Affiliation(s)
- Claudia Menconi
- Proctological and perineal Surgical Unit, Department of Gastroenterology, Cisanello University Hospital, Pisa, Italy
| | - Bernardina Fabiani
- Proctological and perineal Surgical Unit, Department of Gastroenterology, Cisanello University Hospital, Pisa, Italy
| | - Iacopo Giani
- Proctological and perineal Surgical Unit, Department of Gastroenterology, Cisanello University Hospital, Pisa, Italy
| | - Jacopo Martellucci
- General, Emergency and Mininvasive Surgery I, Careggi University Hospital, largo Brambilla 3, 50134, Firenze, Italy.
| | - Gianluca Toniolo
- Proctological and perineal Surgical Unit, Department of Gastroenterology, Cisanello University Hospital, Pisa, Italy
| | - Gabriele Naldini
- Proctological and perineal Surgical Unit, Department of Gastroenterology, Cisanello University Hospital, Pisa, Italy
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Podzemny V, Pescatori LC, Pescatori M. Management of obstructed defecation. World J Gastroenterol 2015; 21:1053-1060. [PMID: 25632177 PMCID: PMC4306148 DOI: 10.3748/wjg.v21.i4.1053] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 08/03/2014] [Accepted: 09/30/2014] [Indexed: 02/06/2023] Open
Abstract
The management of obstructed defecation syndrome (ODS) is mainly conservative and mainly consists of fiber diet, bulking laxatives, rectal irrigation or hydrocolontherapy, biofeedback, transanal electrostimulation, yoga and psychotherapy. According to our experience, nearly 20% of the patients need surgical treatment. If we consider ODS an “iceberg syndrome”, with “emerging rocks”, rectocele and rectal internal mucosal prolapse, that may benefit from surgery, at least two out of ten patients also has “underwater rocks” or occult disorders, such as anismus, rectal hyposensation and anxiety/depression, which mostly require conservative treatment. Rectal prolapse excision or obliterative suture, rectocele and/or enterocele repair, retrograde Malone’s enema and partial myotomy of the puborectalis muscle are effective in selected cases. Laparoscopic ventral sacral colporectopexy may be an effective surgical option. Stapled transanal rectal resection may lead to severe complications. The Transtar procedure seems to be safer, when dealing with recto-rectal intussusception. A multidisciplinary approach to ODS provides the best results.
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Lin HC, Ren DL, He QL, Peng H, Xie SK, Su D, Wang XX. Partial stapled hemorrhoidopexy versus circular stapled hemorrhoidopexy for grade III-IV prolapsing hemorrhoids: a two-year prospective controlled study. Tech Coloproctol 2012; 16:337-43. [PMID: 22402919 DOI: 10.1007/s10151-012-0815-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 02/12/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND Circular stapled hemorrhoidopexy (CSH) is an effective technique for treating prolapsing hemorrhoids; but urgency and anal stenosis are common postoperative complications. The aim of this study was to assess the efficacy and postoperative outcomes of partial stapled hemorrhoidopexy (PSH), compared with CSH. METHODS Seventy-two consecutive patients with grade III and IV hemorrhoids who met the inclusion/exclusion criteria were divided in a non-randomized manner to undergo either PSH (n = 34) or CSH (n = 38). Intraoperative and postoperative parameters in both groups were collected and compared. RESULTS The postoperative visual analog score for pain at first defecation was significantly lower in the PSH group than that in the CSH group (P = 0.001). Fewer patients in the PSH group experienced postoperative urgency, compared with those in the CSH group at 12 h, 1 day, and 7 days after surgery (P = 0.025, P = 0.019, and P = 0.043, respectively). Gas incontinence occurred in 3 patients (7.9%) in the CSH group, but in none of patients in the PSH group (P = 0.242). Postoperative anal stenosis developed in one patient (2.6%) in the CSH group, but in none of the patients in the PSH group (P = 1.0). The 2-year recurrence rate was 2.9 and 5.3%, respectively, in the PSH and CSH groups (P = 1.0). CONCLUSIONS The 2-year recurrence rate is similar in patients with grade III-IV hemorrhoids treated with PSH or CSH. However, PSH is associated with less postoperative pain, fewer episodes of urgency, and no anal incontinence or anal stenosis.
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Affiliation(s)
- H-C Lin
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University (Gastrointestinal and Anal Hospital), 26 Yuancun Er Heng Rd, Guangzhou, 510655, People's Republic of China
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Pescatori M. Hemorrhoids. PREVENTION AND TREATMENT OF COMPLICATIONS IN PROCTOLOGICAL SURGERY 2012:15-56. [DOI: 10.1007/978-88-470-2077-1_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Agraffectomy after low rectal stapling procedures for hemorrhoids and rectocele. Tech Coloproctol 2011; 15:265-6. [PMID: 21748429 DOI: 10.1007/s10151-011-0717-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Accepted: 06/28/2011] [Indexed: 10/18/2022]
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Pescatori M. Emorroidi. PREVENZIONE E TRATTAMENTO DELLE COMPLICANZE IN CHIRURGIA PROCTOLOGICA 2011:15-55. [DOI: 10.1007/978-88-470-2062-7_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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