A comparison of three single layer anastomotic techniques in the colon of the rat

A Trimming Technique: A Case Report of a Novel Surgical Approach for Cesarean Scar Dehiscence During Cesarean Section

Cesarean section can lead to residual myometrial thickness thinning and cesarean scar syndrome. We report a novel trimming technique for residual myometrial thickness recovery in women with cesarean scar syndrome. Case 1: A 33-year-old woman who developed cesarean scar syndrome (CSS) and abnormal uterine bleeding post-cesarean scar became pregnant following hysteroscopic treatment. The myometrium at previous scar was dehiscent; therefore, a transverse incision was made above the scar. Post-operative uterine recovery failed owing to lochia retention, and developed cesarean scar syndrome again. Case 2: A 29-year-old woman who developed cesarean scar syndrome post-cesarean section became pregnant spontaneously. The myometrium at the previous scar was dehiscent like case 1. Scar repair was performed using a trimming technique during cesarean section; there were no subsequent complications and she conceived again spontaneously. Performing this novel surgical procedure during cesarean section may contribute to residual myometrial thickness recovery in women with cesarean scar syndrome.

Effects of exogenous glucagon-like peptide-2 and distal bowel resection on intestinal and systemic adaptive responses in rats

OBJECTIVE

To determine the effects of exogenous glucagon-like peptide-2 (GLP-2), with or without massive distal bowel resection, on adaptation of jejunal mucosa, enteric neurons, gut hormones and tissue reserves in rats.

BACKGROUND

GLP-2 is a gut hormone known to be trophic for small bowel mucosa, and to mimic intestinal adaptation in short bowel syndrome (SBS). However, the effects of exogenous GLP-2 and SBS on enteric neurons are unclear.

METHODS

Sprague Dawley rats were randomized to four treatments: Transected Bowel (TB) (n = 8), TB + GLP-2 (2.5 nmol/kg/h, n = 8), SBS (n = 5), or SBS + GLP-2 (2.5 nmol/kg/h, n = 9). SBS groups underwent a 60% jejunoileal resection with cecectomy and jejunocolic anastomosis. All rats were maintained on parenteral nutrition for 7 d. Parameters measured included gut morphometry, qPCR for hexose transporter (SGLT-1, GLUT-2, GLUT-5) and GLP-2 receptor mRNA, whole mount immunohistochemistry for neurons (HuC/D, VIP, nNOS), plasma glucose, gut hormones, and body composition.

RESULTS

Resection increased the proportion of nNOS immunopositive myenteric neurons, intestinal muscularis propria thickness and crypt cell proliferation, which were not recapitulated by GLP-2 therapy. Exogenous GLP-2 increased jejunal mucosal surface area without affecting enteric VIP or nNOS neuronal immunopositivity, attenuated resection-induced reductions in jejunal hexose transporter abundance (SGLT-1, GLUT-2), increased plasma amylin and decreased peptide YY concentrations. Exogenous GLP-2 attenuated resection-induced increases in blood glucose and body fat loss.

CONCLUSIONS

Exogenous GLP-2 stimulates jejunal adaptation independent of enteric neuronal VIP or nNOS changes, and has divergent effects on plasma amylin and peptide YY concentrations. The novel ability of exogenous GLP-2 to modulate resection-induced changes in peripheral glucose and lipid reserves may be important in understanding the whole-body response following intestinal resection, and is worthy of further study.

Albert-Lembert versus hybrid-layered suture in hand sewn end-to-end cervical esophagogastric anastomosis after esophageal squamous cell carcinoma resection

BACKGROUND

Hand sewn cervical esophagogastric anastomosis (CEGA) is regarded as preferred technique by surgeons after esophagectomy. However, considering the anastomotic leakage and stricture, the optimal technique for performing this anastomosis is still under debate.

METHODS

Between November 2010 and September 2012, 230 patients who underwent esophagectomy with hand sewn end-to-end (ETE) CEGA for esophageal squamous cell carcinoma (ESCC) were analyzed retrospectively, including 111 patients underwent Albert-Lembert suture anastomosis and 119 patients underwent hybrid-layered suture anastomosis. Anastomosis construction time was recorded during operation. Anastomotic leakage was recorded through upper gastrointestinal water-soluble contrast examination. Anastomotic stricture was recorded during follow up.

RESULTS

The hybrid-layered suture was faster than Albert-Lembert suture (29.40±1.24 min vs. 33.83±1.41 min, P=0.02). The overall anastomotic leak rate was 7.82%, the leak rate in hybrid-layered suture group was significantly lower than that in Albert-Lembert suture group (3.36% vs. 12.61%, P=0.01). The overall anastomotic stricture rate was 9.13%, the stricture rate in hybrid-layered suture group was significantly lower than that in Albert-Lembert suture group (5.04% vs. 13.51%, P=0.04).

CONCLUSIONS

Hand sewn ETE CEGA with hybrid-layered suture is associated with lower anastomotic leakage and stricture rate compared to hand sewn ETE CEGA with Albert-Lembert suture.

Influence of adalimumab treatment on anastomotic strength, degree of inflammation, and collagen formation: an experimental study on the small intestine of rabbits

BACKGROUND

Adalimumab is a TNF-α inhibitor, which has gained wide use in the treatment of inflammatory bowel diseases. The potential detrimental effect of TNF-α inhibitors on postoperative complications such as anastomotic leakage is unknown. The aim of this study was to investigate the effect of a single therapeutic dose of adalimumab on anastomotic strength inflammation and collagen formation.

METHODS

Twenty-eight female rabbits (1.8-2.2 kg) were allocated to subcutaneous injection with either adalimumab (1.5 mg/kg) (n=14) or placebo (n=14). One week after medication two separate end-to-end anastomoses were performed in the jejunum. The rabbits were killed on the third postoperative day. The anastomosis were subjected to tensile strength analysis and histopathological examination.

RESULTS

No statistically significant differences were found between the two groups regarding maximum tensile strength, inflammation parameters and collagen formation in the anastomosis area. Multiple regression analysis showed no association between maximum tensile strength histological changes, time under anaesthesia, duration of surgery, weight gain, weight loss and number of sutures in either group.

CONCLUSION

We found no statistically significant effect of a single therapeutic dose of adalimumab on anastomotic strength, histological parameters or collagen formation in rabbits.

Cecorraphy in single layer using polypropylene and poliglecaprone 25 threads: comparative study in rats

PURPOSE: To compare sutures with polypropylene and poliglecaprone 25 after partial cecotomy in rats. METHODS: Thirty six rats divided into two groups, A and B, of 18 animals; each group was also divided into three subgroups of six animals sacrificed at 4th, 7th and 14th days after surgery. Were studied the mortality, morbidity, complications attributable to sutures, macroscopy, optical microscopy and measurement of hydroxyproline at the level of the suture. RESULTS: There were no deaths or wound complications such as hematoma, seroma, abscess, evisceration or eventration. On microscopic evaluation reepithelization, coaptation and inflammation in both groups did not differ significantly. The average rate of tissue hydroxyproline found in the samples on the 4th day after surgery, was 21.38 mg/g tissue for group A and 16.68 mg/g for group B; on day 7 after surgery, the average was 15.64 mg/g tissue for group A and 26.53 mg/g for group B; on day 14, the average was 8.09 mg/g tissue for group A and 25.07 mg/g for group B. CONCLUSION: There were no differences on clinical evolution, macroscopic aspect, microscopic data and hydroxyproline concentration on both sutures.

A comparison of two anastomotic techniques in the jejunum of the goat

This study was carried out to test two different anastomotic techniques to identify advantages and disadvantages of each technique in goats. All animals were under local infiltration anaesthesia. A five-cm length of jejunum was resected from the first part of the jejunum and end to end anastomosis using 3-0 Polygalactin-910 with one row of sero-submoucosal interrupted sutures (SSIS) group, and one row of horizontal mattress interrupted sutures (HMIS) group. Two animals from each group were euthanized on the 4th, 14th and 21st postoperative days. A 7-cm segment of jejunum including the anastomosed area was resected from each animal. There was no significant adhesion between anastomosis area and surrounded tissues observed in SSIS animals, while there was significant adhesion between anastomosis area and surrounded tissues which were observed in HMIS animals. Stenosis degree was lower in the SSIS than the HMIS group. The bursting pressure was higher in the SSIS than the HMIS group. Macroscopic evaluation indicated that the anastomotic line mucosa was abridged better with less local edema in the SSIS group. Histological evaluation in the SSIS group showed almost all parameters such as epithelial recovery and repair of submucosal-mucosal layer demonstrated better healing compared to the HMIS group.