1
|
Shibutani M, Fukuoka T, Iseki Y, Kasashima H, Maeda K. Efficacy of the polyglycolic acid sheet for preventing anastomotic leakage in double-stapling technique anastomosis for left-sided colon or rectal cancer surgery: a propensity score-matched study. BMC Surg 2023; 23:135. [PMID: 37198625 DOI: 10.1186/s12893-023-02044-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 05/11/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND To prevent anastomotic leakage in patients with left-sided colorectal cancer who underwent double-stapling technique (DST) anastomosis, we investigated a new method: DST anastomosis with a polyglycolic acid (PGA) sheet. This procedure has been shown to have the potential to decrease the rate of anastomotic leakage. However, due to the small number of cases enrolled in our previous study, it was not possible to compare the outcomes of the new and conventional procedures. The aim of this study was to evaluate the effect of the PGA sheet on preventing anastomotic leakage in patients with left-sided colorectal cancer who underwent DST anastomosis by retrospectively comparing the anastomotic leakage rate between the PGA sheet and conventional groups. METHODS A total of 356 patients with left-sided colorectal cancer who underwent DST anastomosis during surgery at Osaka City University Hospital between January 2016 and April 2022 were enrolled in this study. Propensity score matching was performed to reduce the confounding effects secondary to imbalances in the use of PGA sheets. RESULTS The PGA sheet was used in 43 cases (PGA sheet group) and it was not used in 313 cases (conventional group). After propensity score matching, the incidence of anastomotic leakage in the PGA sheet group was significantly lower than that in the conventional group. CONCLUSION DST anastomosis with PGA sheet, which is easy to perform, contributes to the reduction of anastomotic leakage rate by increasing the strength of the anastomotic site.
Collapse
Affiliation(s)
- Masatsune Shibutani
- Department of Gastroenterological Surgery, Osaka metropolitan university graduate school of medicine, 1-4-3 Asahi-machi Abeno-ku, Osaka City, 545-8585, Osaka Prefecture, Japan.
| | - Tatsunari Fukuoka
- Department of Gastroenterological Surgery, Osaka metropolitan university graduate school of medicine, 1-4-3 Asahi-machi Abeno-ku, Osaka City, 545-8585, Osaka Prefecture, Japan
| | - Yasuhito Iseki
- Department of Gastroenterological Surgery, Osaka metropolitan university graduate school of medicine, 1-4-3 Asahi-machi Abeno-ku, Osaka City, 545-8585, Osaka Prefecture, Japan
| | - Hiroaki Kasashima
- Department of Gastroenterological Surgery, Osaka metropolitan university graduate school of medicine, 1-4-3 Asahi-machi Abeno-ku, Osaka City, 545-8585, Osaka Prefecture, Japan
| | - Kiyoshi Maeda
- Department of Gastroenterological Surgery, Osaka metropolitan university graduate school of medicine, 1-4-3 Asahi-machi Abeno-ku, Osaka City, 545-8585, Osaka Prefecture, Japan
| |
Collapse
|
2
|
Udayakumar SIV, Kwon D, Kwon TG, Paeng JY. Secondary healing property using Neoveil®, a polyglycolic acid bioabsorbable sheet on the oral mucosal defects. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101259. [PMID: 35940562 DOI: 10.1016/j.jormas.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 07/24/2022] [Accepted: 08/04/2022] [Indexed: 10/16/2022]
Abstract
Neoveil® is a wound surface-covering agent composed of polyglycolic acid(PGA) effective for secondary healing. This study evaluated the secondary healing property of oral cavity mucosal defects using the PGA sheet. Thirty-four patients who underwent surgical excision of oral benign and malignant lesions, precancerous lesions, and tumors were evaluated. The PGA sheet was placed over the open wound to aid secondary healing. The defects were reviewed post-operatively for secondary healing, contracture, and secondary deformity. Male to female ratio was 20:14, and the mean age was 63.5 years. In all cases, the oral mucosal defect was present after the wide excision of the mucosal lesion. The PGA sheet was used as a surface covering agent which was found to be effective in secondary healing of the wound. Any side effects and adverse reactions which were caused by the PGA sheet was not evident. It can be used to avoid skin graft or free flap reconstruction or deformity from the direct closure in moderate size oral mucosal defect.
Collapse
Affiliation(s)
- Santhiya Iswarya Vinothini Udayakumar
- Department of Oral and Maxillofacial Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, Republic of Korea
| | - Dohyun Kwon
- Department of Oral and Maxillofacial Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, Republic of Korea
| | - Tae-Geon Kwon
- Department of Oral & Maxillofacial Surgery, School of Dentistry, Kyungpook National University, Daegu, Republic of Korea
| | - Jun-Young Paeng
- Department of Oral and Maxillofacial Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, Republic of Korea.
| |
Collapse
|
3
|
Kim JS, Lee TY, Kwak BJ, Lee JS, Kwon YK, Yoon YC. Arterial reinforcement following pancreatoduodenectomy: The solution to prevent delayed hemorrhage caused by postoperative pancreatic fistula. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2022. [PMID: 36458401 DOI: 10.1002/jhbp.1294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 11/25/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE Delayed hemorrhage (DH) is a rare and yet well-known fatal complication associated with postoperative pancreatic fistula (POPF) in pancreatoduodenectomy (PD). The study aimed to investigate whether arterial reinforcement (AR) using polyglycolic acid sheets (PAS) followed by fibrin sealant (FS) to the hepatic artery could prevent DH in the setting of POPF after PD. METHODS A total of 345 patients underwent PD for periampullary tumors from March 2011 to March 2022. From March 2011 to March 2018, 225 patients underwent PD, and AR was not performed (non-AR group). From April 2018 to March 2022, 120 patients underwent PD, and AR was performed (AR group). AR was achieved by wrapping the proper hepatic artery all the way down to the celiac artery with PAS followed by coating with FS. Demographic profile and various outcomes including DH of these two groups were compared and analyzed retrospectively. RESULTS In non-AR group, 48 (21.3%) and 12 (5.3%) patients had grade B and C POPF, respectively. In AR group, 26 (21.7%) and four (3.3%) patients had grade B and C POPF, respectively. The incidence of POPF was not statistically significant (p = .702) between the groups. Among the patients with grade B or C POPF, DH occurred in 14 (23.3%) patients in non-AR group and only one patient in AR group (p = .016). Of the 15 patients with DH, four (26.7%) patients died. CONCLUSION AR using PAS and FS is effective in preventing DH in the setting of POPF.
Collapse
Affiliation(s)
- Ji Su Kim
- Division of Hepatobiliary, Pancreas, and Abdominal Organ Transplant, Department of Surgery, The Catholic University of Korea Incheon St. Mary's Hospital, Incheon, Republic of Korea
| | - Tae Yoon Lee
- Division of Hepatobiliary, Pancreas, and Abdominal Organ Transplant, Department of Surgery, The Catholic University of Korea Incheon St. Mary's Hospital, Incheon, Republic of Korea
| | - Bong Jun Kwak
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jun Suh Lee
- Department of Surgery, Seoul National University, College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Yong Kyong Kwon
- Division of Hepatobiliary, Pancreas, and Abdominal Organ Transplant, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Young Chul Yoon
- Division of Hepatobiliary, Pancreas, and Abdominal Organ Transplant, Department of Surgery, The Catholic University of Korea Incheon St. Mary's Hospital, Incheon, Republic of Korea
| |
Collapse
|
4
|
Shibutani M, Nagahara H, Fukuoka T, Iseki Y, Okazaki Y, Hirakawa K, Ohira M. Prevention of anastomotic leakage using a polyglycolic acid sheet in double-stapling technique anastomosis for rectal surgery. Ann Med Surg (Lond) 2021; 72:103117. [PMID: 34888048 PMCID: PMC8637182 DOI: 10.1016/j.amsu.2021.103117] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/20/2021] [Accepted: 11/21/2021] [Indexed: 11/17/2022] Open
Abstract
Background Due to the development of surgical techniques and devices, the incidence of anastomosis leakage in rectal surgery has decreased. However, anastomotic leakage in rectal surgery remains a serious postoperative complication. The present study examined whether or not a polyglycolic acid (PGA) sheet is effective for reinforcing rectal anastomosis. Material and methods Fifteen patients who underwent double-stapling technique (DST) anastomosis during rectal surgery were enrolled in this study. The PGA sheet was used as the reinforcing material. DST anastomosis was performed with the PGA sheet sandwiched, and a strip of the PGA sheet was wrapped around the anastomosis. Results No patients had anastomotic leakage. Conclusion A PGA sheet may be effective for preventing anastomotic leakage in DST anastomosis for rectal surgery. The new method for preventing anastomotic leakage in rectal surgery. A polyglycolic acid (PGA) sheet which is absorbable reinforcement material was used. Thanks to the use of the PGA sheet, no patients had anastomotic leakage.
Collapse
Affiliation(s)
- Masatsune Shibutani
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hisashi Nagahara
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Tatsunari Fukuoka
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yasuhito Iseki
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yuki Okazaki
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kosei Hirakawa
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masaichi Ohira
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| |
Collapse
|
5
|
Tokat T, Muderris T, Aysel A, Sari E, Erol F. The efficiency of polyglycolic acid felt in the prevention of pharyngocutaneous fistula after total laryngectomy. Am J Otolaryngol 2021; 42:103164. [PMID: 34352675 DOI: 10.1016/j.amjoto.2021.103164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 07/17/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Taskin Tokat
- Department of Otolaryngology - Head and Neck Surgery, Sakarya University Education and Research Hospital, Sakarya, Turkey.
| | - Togay Muderris
- Department of Otolaryngology - Head and Neck Surgery, Bakircay University, Faculty of Medicine, Izmir, Turkey
| | - Abdulhalim Aysel
- Department of Otolaryngology - Head and Neck Surgery, Bozyaka Education and Research Hospital, Izmir, Turkey
| | - Elif Sari
- Department of Otolaryngology - Head and Neck Surgery, Mustafa Kemal University Faculty of Medicine, Hatay, Turkey
| | - Ferda Erol
- Department of Otolaryngology - Head and Neck Surgery, Bozyaka Education and Research Hospital, Izmir, Turkey
| |
Collapse
|
6
|
Reduction in Anastomotic Leakage Using Bioabsorbable Material with a Circular Stapler in a Porcine Model. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02302-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
7
|
Kim WJ, Lee CM, An L, Kim JH, Park S. Effect of Biologic Material Reinforcement on Surgical Anastomosis After Gastrectomy-A Pilot Study. Front Oncol 2019; 9:1184. [PMID: 31781494 PMCID: PMC6851234 DOI: 10.3389/fonc.2019.01184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 10/21/2019] [Indexed: 01/24/2023] Open
Abstract
Background: Acellular dermal matrix is a biologic material derived from the skin of human cadaveric donors. It has been used successfully in the past to reduce complications in breast surgery and hernia repair. This investigation was aimed at assessing the feasibility of using acellular dermal matrix to support the anastomosis after gastrectomy with the aim of reducing anastomotic site leakage complications. Methods: Patients were randomly assigned to standard anastomotic reconstruction (control arm) or anastomotic reconstruction with acellular dermal matrix reinforcement (intervention arm). Surgical outcomes related to anastomotic complications were collected. Because actual anastomotic leaks found on imaging studies are infrequent and thus require a very high number of patient recruitment to detect statistically significant difference between the two groups, in this pilot investigation other clinical and laboratory measures that have been shown to correlate to or predict anastomotic leaks were also collected. Each surgical outcome was compared. Results: A total of 94 patients (intervention arm: 50, control arm: 44), were included in the analysis. Two patients in the control arm (4.55%) and one patient in the intervention arm (2.00%) experienced anastomotic leakage (p = 0.598), a difference without statistical significance. However, average postoperative C-reactive protein (CRP) levels and NUn scores, both of which have been shown to reflect likelihood of progressing to anastomotic leakage, were significantly lower for the intervention arm. The control arm showed an average CRP level of 128.77 mg/dL (SD: 97.08) while the intervention arm showed 77.38 mg/dL (SD: 49.08, p = 0.049). Conclusions: Leakage rate reduction with acellular dermal matrix reinforcement of anastomotic site was not detected in this investigation. However, postoperative inflammation levels and numerical predictors of anastomotic leakage development were significantly lower with acellular dermal matrix reinforcement of surgical anastomosis. This finding is worthy of further investigation, as reduction of inflammation with anastomotic site reinforcement is a novel finding, and more in-depth research may lead to discoveries on the physiologic role of the surgical anastomosis in post-gastrectomy patients. In addition, lower CRP and NUn scores for the intervention arm suggest potential for larger studies to detect reduction in clinical leak rates after acellular dermal matrix reinforcement.
Collapse
Affiliation(s)
- Won Jun Kim
- Korea University Medical Center, College of Medicine, Seoul, South Korea
| | - Chang Min Lee
- Department of Surgery, Korea University Medical Center, Ansan Hospital, Ansan, South Korea
| | - Liang An
- Korea University Medical Center, College of Medicine, Seoul, South Korea
| | - Jong-Han Kim
- Department of Surgery, Korea University Medical Center, Guro Hospital, Seoul, South Korea
| | - Sungsoo Park
- Department of Surgery, Korea University Medical Center, Anam Hospital, Seoul, South Korea
| |
Collapse
|
8
|
Song YN, Qi Y, Zhang CY, Sheng YL, Wu K, Zhu SL, Han L, Shan TT, Ye GC, Zhang QY, Chen YL, Chen JW, Liu YF, Gao LB, Yang Y, He ZF, Zhu DY, Liu DL, Wen FB, Zheng TL, Li JL, Zhao S. A new technology for reducing anastomotic fistula in the neck after esophageal cancer surgery. J Thorac Dis 2019; 11:3084-3092. [PMID: 31463137 DOI: 10.21037/jtd.2019.07.28] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background To explore the risk factors and prevention methods of cervical mechanical anastomotic fistula and stenosis after the radical resection of esophageal cancer. Methods From March 2018 to November 2018, 128 patients undergoing mechanical anastomosis of esophageal cancer were selected from the Department of Thoracic Surgery of The First Affiliated Hospital of Zhengzhou University. All the enrolled patients were operated on using the Mckeown method, and a retrospective study was conducted. Data for preoperative and postoperative test indices, intraoperative embedding materials, postoperative complications, and preoperative and postoperative treatment were collected, and the relationship between various factors and the incidence of cervical anastomotic fistula and stenosis was analysed. Univariate analysis was conducted using t tests or Fisher's exact probability method, and multivariate analysis was conducted using logistic regression models. Results All 128 patients successfully underwent surgery without dying. The enrolled patients were evaluated using the Stooler classification, with 28 patients having grade 0, 41 patients having grade 1, 34 patients having grade 2, 21 patients having grade 3, and 4 patients having grade 4 stenosis. Patients with stenosis of grade 3 or above had obvious choking sensation, which could only be relieved by balloon dilation. Symptoms in all patients with stenosis were relieved by balloon dilation. There were no significant differences between the two groups regarding embedding materials, preoperative choking history, history of alcohol consumption, history of hypertension, history of coronary heart disease, history of diabetes, postoperative calcium concentration, average albumin concentration, average platelet concentration, body mass index, anastomotic fistula, preoperative chemotherapy, postoperative chemotherapy, or postoperative cough (P>0.05). There were significant differences in postoperative reflux (χ2=11.338, P<0.05) and scar constitution (χ2=12.497, P<0.05). The effects of embedding materials in patients with anastomotic fistula were significantly different (χ2=4.372, P<0.05). Conclusions Postoperative reflux and scar constitution may be risk factors for postoperative anastomotic stenosis after resection of esophageal cancer. There was almost no difference in the effects on esophageal anastomotic stenosis between embedding materials and the omentum majus, but Neoveil® may have certain advantages in preventing cervical anastomotic fistula, and thus may have certain clinical application value.
Collapse
Affiliation(s)
- Ya-Nan Song
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Yu Qi
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Chun-Yang Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Yin-Liang Sheng
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Kai Wu
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Sen-Lin Zhu
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Lu Han
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Ting-Ting Shan
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Guan-Chao Ye
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Qing-Yi Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Yan-Li Chen
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Jin-Wei Chen
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Ya-Fei Liu
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Lu-Bing Gao
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Yang Yang
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Zhan-Feng He
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Deng-Yan Zhu
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Dong-Lei Liu
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Feng-Biao Wen
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Tian-Liang Zheng
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Ji-Lun Li
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Song Zhao
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| |
Collapse
|
9
|
Validation of the vulnerable crotch on a side-to-side anastomosis: Observation of the burst process. Eur Surg 2018. [DOI: 10.1007/s10353-018-0561-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
10
|
|
11
|
Improving the side-to-side stapled anastomosis: comparison of staplers for robust crotch formation. Surg Obes Relat Dis 2017; 14:16-21. [PMID: 29108894 DOI: 10.1016/j.soard.2017.09.532] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 09/20/2017] [Accepted: 09/26/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Few studies have investigated the burst pressure of side-to-side anastomoses comparing different stapling devices that are commercially available. OBJECTIVES We conducted side-to-side anastomoses with a variety of staplers and compared burst pressure in the crotch of the anastomoses. SETTING Nagoya City East Medical Center. METHODS We conducted side-to-side anastomoses with 9 staplers with different shapes and forms. Fresh pig small intestines were used. A side-to-side anastomosis was performed between 2 intestine specimens using a linear stapler. The burst pressure of the anastomosis was recorded. RESULTS In total, 45 staplers were used for this experiment. The site of leakage in all cases was the crotch. Regarding the influence of the number of staple rows, the burst pressure in 3-row staplers was significantly higher than in 2-row staplers. With regard to the relationship between staple height and burst pressure, staples with a height slightly shorter than the intestinal thickness showed the highest burst pressure. In a comparison of staplers with uniform staple heights and stamplers with staples of 3 different heights, the latter had significantly lower burst pressures. Neoveil significantly increased the burst pressure in the crotch and contributed to the highest burst pressure of all the staplers used in this experiment. CONCLUSIONS In this experiment, we defined the important factors that influence burst pressure at the crotch of a stapled, side-to-side anastomosis. These factors include the number of staple rows, the height of the staple compared with the thickness of the tissue, uniformity of staple height, and reinforcement of the staple line. In any surgical case requiring intestinal anastomosis, selection of a stapler is a critical step.
Collapse
|
12
|
di Saverio S, Birindelli A, Segalini E, Todero S, Botusan RA, Novello M, Kwan S, Biondi A. A novel technique for enterotomy closure in stapled laparoscopic intracorporeal anastomosis. Colorectal Dis 2017; 19:O372-O376. [PMID: 28833963 DOI: 10.1111/codi.13856] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 08/01/2017] [Indexed: 02/08/2023]
Abstract
AIM The proximal edge of the enterotomy in a side-to-side anastomosis has been shown to be the site at highest risk of leakage. Several methods have been described to overcome this vulnerability. The technical challenge of intra-corporeal anastomosis (ICA) is to re-create angles between tissues and instruments, similar to those in an open anastomosis. The axis between the suture line and the needle driver is paramount and this angle should be < 45°. METHOD The crotch stitch of the enterotomy is difficult because of the narrow space between the loops and the depth of the anastomosis. The usual technique is suturing right-handed, 'out-in and in-out', colonic edge first to small bowel. The risk of suture misplacement (e.g. 'out-in/out-in' or 'out-out') is similar to open procedures but laparoscopically the second bite is challenging, due to the straight needle-driver. This may lead to asymmetrical closure of the corner resulting in a slightly larger angle on the bowel side and a potential postoperative leak/fistula. Rotating the small bowel loop to counterbalance this issue, risks tearing of the staple line. The rationale is that starting with a back-handed stitch and taking the small bowel edge first would allow the necessary acute angled bite to be achieved. Subsequently, mounting the needle right-handed for taking the colonic edge also allows achievement of an acute angled bite. RESULTS Our novel technique, named the 'back-handed, left-to-right stitch' technique, is intended to achieve symmetrical approximation of the ileal and colonic edges during laparoscopy, with an optimal closure of the deepest extremity of the enterotomy. Such a stitch, used in a series of 10 patients, may be useful to avoid leaving an opening within this angle and/or to avoid potential technical pitfalls when closing the deepest apex of the enterotomy. CONCLUSION This 'back-handed, left-to-right' stitch described here allows a properly angled closure of the proximal edge of the enterotomy and a safe approximation of the corner of the enterotomy in a side-to-side ICA.
Collapse
Affiliation(s)
- S di Saverio
- Maggiore Hospital Regional Emergency Surgery and Trauma Center, Bologna Local Health District, Bologna, Italy
| | - A Birindelli
- Maggiore Hospital Regional Emergency Surgery and Trauma Center, Bologna Local Health District, Bologna, Italy
| | - E Segalini
- Maggiore Hospital Regional Emergency Surgery and Trauma Center, Bologna Local Health District, Bologna, Italy
| | - S Todero
- Maggiore Hospital Regional Emergency Surgery and Trauma Center, Bologna Local Health District, Bologna, Italy
| | - R A Botusan
- Maggiore Hospital Regional Emergency Surgery and Trauma Center, Bologna Local Health District, Bologna, Italy
| | - M Novello
- Colorectal Surgery Department, Cleveland Clinic, Cleveland, Ohio, USA
| | - S Kwan
- Royal Perth Hospital, University of Western Australia, Australia
| | - A Biondi
- Department of Surgery, University of Catania, Catania, Italy
| |
Collapse
|
13
|
Naito M, Sato T, Nakamura T, Yamanashi T, Miura H, Tsutsui A, Watanabe M. Secure overlap stapling using a linear stapler with bioabsorbable polyglycolic acid felt. Asian J Endosc Surg 2017; 10:308-312. [PMID: 28224709 DOI: 10.1111/ases.12364] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 01/17/2017] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Despite the availability of various anastomosis techniques, postoperative anastomotic complications such as anastomosis failure and bleeding develop in some patients. Automatic suturing devices have been widely used for gastrointestinal anastomosis. However, overly thick or thin tissue, displacement of tissue, and the creation of a staple-on-staple site may lead to incomplete staple formation. These factors are considered to be related to postoperative complications such as anastomosis failure. METHODS The iDrive™ Ultra Powered Stapling System was used to fire the automatic suturing device. Two types of automatic suturing devices were employed: (i) the Endo GIA™ Reinforced Reload with Tri-Staple™ Technology with a cartridge with the reinforcement material Neoveil™; and (ii) the Endo GIA™ with Tri-Staple™ Technology with no reinforcement material. Stapling was performed using a two-stage crossing approach to make a staple-on-staple site. RESULTS The rates of complete formation with the Endo GIA™ with Tri-Staple™ Technology were 95.6 ± 0.6% for stomach tissue and 95.6 ± 2.3% for colon tissue, which is thinner than stomach tissue. In contrast, the rates of complete formation with the Endo GIA™ Reinforced Reload with Tri-Staple™ Technology were 99.3 ± 1.27% for stomach tissue and 100.0 ± 0.0% for colon tissue. CONCLUSION Our results showed that the Endo GIA™ Reinforced Reload with Tri-Staple™ Technology had higher rates of complete staple formation than the Endo GIA™ with Tri-Staple™ Technology, irrespective of tissue thickness and the presence of a staple-on-staple site.
Collapse
Affiliation(s)
- Masanori Naito
- Department of Surgery, Kitasato University, School of Medicine, Sagamihara, Japan
| | - Takeo Sato
- Department of Surgery, Kitasato University, School of Medicine, Sagamihara, Japan
| | - Takatoshi Nakamura
- Department of Surgery, Kitasato University, School of Medicine, Sagamihara, Japan
| | - Takahiro Yamanashi
- Department of Surgery, Kitasato University, School of Medicine, Sagamihara, Japan
| | - Hirohisa Miura
- Department of Surgery, Kitasato University, School of Medicine, Sagamihara, Japan
| | - Atsuko Tsutsui
- Department of Surgery, Kitasato University, School of Medicine, Sagamihara, Japan
| | - Masahiko Watanabe
- Department of Surgery, Kitasato University, School of Medicine, Sagamihara, Japan
| |
Collapse
|
14
|
Naito M, Miura H, Nakamura T, Sato T, Yamanashi T, Tsutsui A, Watanabe M. Sutureless functional end-to-end anastomosis using a linear stapler with polyglycolic acid felt for intestinal anastomoses. Ann Med Surg (Lond) 2017; 17:50-53. [PMID: 28408988 PMCID: PMC5382030 DOI: 10.1016/j.amsu.2017.03.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 03/29/2017] [Accepted: 03/29/2017] [Indexed: 02/05/2023] Open
Abstract
Background Gastrointestinal anastomosis remains associated with a considerable burden of morbidity and, in some cases, mortality. Functional end-to-end anastomosis, whilst extremely efficient, is vulnerable to increased intestinal pressure in the immediate postoperative period, which may predispose to development of anastomotic leakage or bleeding. Therefore, there is a requirement for new techniques that facilitate safe and efficacious anastomotic procedures. Materials and methods This study examined the clinical application of functional end-to-end anastomosis with a stapler that automatically applies a bioabsorbable polyglycolic acid sheet (Endo GIA™ Reinforced Reload with Tri-Staple™ Technology). A porcine model was used to examine functional end-to-end anastomosis with and without application of a bioabsorbable polyglycolic acid sheet. As the crotch of the anastomosis is considered the weakest point, a probe was used to test the integrity of these anastomoses. Furthermore, we performed functional end-to-end anastomosis using the Endo GIA™ Reinforced stapler in a clinical series of 20 patients undergoing gastrointestinal tract resection. In all cases, functional end-to-end anastomosis was performed without suture reinforcement. Results Small intestine anastomoses in the animal study exhibited no weakness at the crotch of the anastomosis, as tested with a probe, suggesting an increased resiliency to conventional complications of functional end-to-end anastomosis. In the clinical population, no postoperative complications were noted. No adhesive intestinal obstruction was noted. Conclusion Sutureless functional end-to-end anastomosis using the Endo GIA™ Reinforced appears to be safe, efficacious, and straightforward. Reinforcement of the crotch site with a bioabsorbable polyglycolic acid sheet appears to mitigate conventional problems with crotch-site vulnerability. Functional end-to-end anastomosis is safe with the Endo GIA™ Reinforced stapler. Conventional functional end-to-end anastomosis requires suture reinforcement. The Endo GIA™ Reinforced allows sutureless anastomosis by creating staple planes.
Collapse
Affiliation(s)
- Masanori Naito
- Kitasato University, School of Medicine, Department of Surgery, Sagamihara, Kanagawa 252-0374, Japan
| | - Hirohisa Miura
- Kitasato University, School of Medicine, Department of Surgery, Sagamihara, Kanagawa 252-0374, Japan
| | - Takatoshi Nakamura
- Kitasato University, School of Medicine, Department of Surgery, Sagamihara, Kanagawa 252-0374, Japan
| | - Takeo Sato
- Kitasato University, School of Medicine, Department of Surgery, Sagamihara, Kanagawa 252-0374, Japan
| | - Takahiro Yamanashi
- Kitasato University, School of Medicine, Department of Surgery, Sagamihara, Kanagawa 252-0374, Japan
| | - Atsuko Tsutsui
- Kitasato University, School of Medicine, Department of Surgery, Sagamihara, Kanagawa 252-0374, Japan
| | - Masahiko Watanabe
- Kitasato University, School of Medicine, Department of Surgery, Sagamihara, Kanagawa 252-0374, Japan
| |
Collapse
|