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Sun Q, Yang Z, Xu R, Li R, Li Y, Wang F, Li Y. Smart responsive staple for dynamic promotion of anastomotic stoma healing. Bioact Mater 2024; 39:630-642. [PMID: 38883312 PMCID: PMC11180322 DOI: 10.1016/j.bioactmat.2024.04.021] [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: 03/28/2024] [Revised: 04/19/2024] [Accepted: 04/21/2024] [Indexed: 06/18/2024] Open
Abstract
The precise combination of conflicting biological properties through sophisticated structural and functional design to meet all the requirements of anastomotic healing is of great demand but remains challenging. Here, we develop a smart responsive anastomotic staple (Ti-OH-MC) by integrating porous titanium anastomotic staple with multifunctional polytannic acid/tannic acid coating. This design achieves dynamic sequential regulation of antibacterial, anti-inflammatory, and cell proliferation properties. During the inflammatory phase of the anastomotic stoma, our Ti-OH-MC can release tannic acid to provide antibacterial and anti-inflammatory properties, together with immune microenvironment regulation function. At the same time, as the healing progresses, the multifunctional coating gradually falls off to expose the porous structure of the titanium anastomotic staple, which promotes cell adhesion and proliferation during the later proliferative and remodeling phases. As a result, our Ti-OH-MC exceeds the properties of clinically used titanium anastomotic staple, and can effectively promote the healing. The staple's preparation strategy is simple and biocompatible, promising for industrialisation and clinical application. This work provides an effective anastomotic staple for anastomotic stoma healing and serve as a reference for the functional design and preparation of other types of titanium-based tissue repair materials.
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Affiliation(s)
- Qi Sun
- School of Medicine, South China University of Technology, Guangzhou, Guangdong, 510006, China
- Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - Zifeng Yang
- Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - Ruijun Xu
- School of Medicine, South China University of Technology, Guangzhou, Guangdong, 510006, China
- Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - Renjie Li
- Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - Yang Li
- Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - Feng Wang
- Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
- Guangxi Key Laboratory of Green Chemical Materials and Safety Technology, Guangxi Engineering Research Center for New Chemical Materials and Safety Technology, College of Petroleum and Chemical Engineering, Beibu Gulf University, Qinzhou, 535011, China
| | - Yong Li
- School of Medicine, South China University of Technology, Guangzhou, Guangdong, 510006, China
- Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
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Moroi R, Shiga H, Nochioka K, Chiba H, Shimoyama Y, Onodera M, Naito T, Tosa M, Kakuta Y, Sato Y, Kayaba S, Takahashi S, Miyata S, Kinouchi Y, Masamune A. A Phase II Clinical Trial to Study the Safety of Triamcinolone after Endoscopic Radial Incision and Cutting Dilatation for Benign Stenosis of the Lower Gastrointestinal Tract: A Study Protocol. Kurume Med J 2024; 70:53-60. [PMID: 38508736 DOI: 10.2739/kurumemedj.ms7012005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
BACKGROUND Lower gastrointestinal tract stenosis is commonly diagnosed and is typically treated with surgery or endoscopic balloon dilation (EBD). Radial incision and cutting (RIC) is a novel treatment approach that has several benefits compared with EBD and surgery. Although RIC has demonstrated a high technical success rate and has been shown to improve subjective symptoms, previous studies revealed that restenosis after RIC remain unsolved. Herein, we report the design of a prospective, multicenter, single-arm, interventional, phase II trial to evaluate the safety of local triamcinolone acetonide (TA) administration and its feasibility in preventing restenosis after RIC for lower gastrointestinal tract stenosis. METHODS The major inclusion criteria are age 20-80 years and the presence of benign stenosis in the lower gastrointestinal tract accessible by colonoscope. We will perform RIC followed by local administration of TA to 20 participants. The primary outcome is the safety of local TA administration, which will be assessed by determining the frequency of adverse events of special interest. The secondary outcomes are the technical success rate of RIC, duration of procedure, improvement in subjective symptoms, and duration of hospitalization. The outcomes, improvement in subjective symptoms, and long-term results will be evaluated using descriptive statistics, Student's t-test, and Kaplan-Meier curve, respectively. DISCUSSION This explorative study will provide useful information regarding the safety of TA administration after RIC, which may contribute to further investigations.
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Affiliation(s)
- Rintaro Moroi
- Division of Gastroenterology, Tohoku University Hospital
| | - Hisashi Shiga
- Division of Gastroenterology, Tohoku University Hospital
| | - Kotaro Nochioka
- Clinical Research, Innovation and Education Center, Tohoku University Hospital
| | - Hirofumi Chiba
- Division of Gastroenterology, Iwate Prefectural Isawa Hospital
| | | | | | - Takeo Naito
- Division of Gastroenterology, Tohoku University Hospital
| | - Masaki Tosa
- Division of Gastroenterology, Iwaki City Medica Center
| | - Yoichi Kakuta
- Division of Gastroenterology, Tohoku University Hospital
| | - Yuichiro Sato
- Division of Gastroenterology, Osaki Citizen Hospital
| | - Shoichi Kayaba
- Division of Gastroenterology, Iwate Prefectural Isawa Hospital
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Kang SI, Shin HH, Hyun DH, Yoon G, Park JS, Ryu JH. Double-layer adhesives for preventing anastomotic leakage and reducing post-surgical adhesion. Mater Today Bio 2023; 23:100806. [PMID: 37766901 PMCID: PMC10520874 DOI: 10.1016/j.mtbio.2023.100806] [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: 06/10/2023] [Revised: 09/06/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
Preventing anastomotic leakage (AL) and postoperative adhesions after gastrointestinal surgery is crucial for ensuring a favorable surgical prognosis. However, AL prevention using tissue adhesives can unintentionally lead to undesirable adhesion formation, while anti-adhesive agents may interfere with wound healing and contribute to AL. In this study, we have developed a double-layer patch, consisting of an adhesive layer on one side, utilizing gallic acid-conjugated chitosan (CHI-G), and an anti-adhesive layer on the opposite side, employing crosslinked hyaluronic acid (cHA). These CHI-G/cHA double-layer adhesives significantly prevented AL by forming physical barriers of CHI-G and reduced post-surgical adhesion at the anastomosis sites by the anti-adhesive layers of cHA. The bursting pressure (161.1 ± 21.6 mmHg) of double-layer adhesives-applied rat intestine at postoperative day 21 was far higher than those of the control (129.4 ± 5.7 mmHg) and the commercial anti-adhesives-applied group (120.8 ± 5.2 mmHg). In addition, adhesion score of double-layer adhesives-applied rat intestine was 3.6 ± 0.3 at postoperative day 21, which was similar to that of the commercial anti-adhesives-applied group (3.6 ± 0.3) and lower than that of the control group (4.9 ± 0.5). These findings indicate that the double-layer patch (CHI-G/cHA) has the potential to effectively prevent both postoperative adhesions and anastomotic leakage, offering a promising solution for gastrointestinal surgery.
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Affiliation(s)
- Sung Il Kang
- Department of Surgery, College of Medicine, Yeungnam University, Daegu, 42415, South Korea
| | - Hyun Ho Shin
- Department of Chemical Engineering, Wonkwang University, Iksan, Jeonbuk, 54538, South Korea
| | - Da Han Hyun
- Department of Biomedical Science, School of Medicine, Kyungpook National University, Daegu, 41404, South Korea
| | - Ghilsuk Yoon
- Department of Pathology, School of Medicine, Kyungpook National University, Daegu, 41566, South Korea
| | - Jun Seok Park
- Department of Surgery, School of Medicine, Kyungpook National University Hospital, Daegu, 41404, Republic of Korea
| | - Ji Hyun Ryu
- Department of Chemical Engineering, Wonkwang University, Iksan, Jeonbuk, 54538, South Korea
- Department of Carbon Convergence Engineering, Wonkwang University, Iksan, Jeonbuk, 54538, South Korea
- Smart Convergence Materials Analysis Center, Wonkwang University, Iksan, Jeonbuk, 54538, South Korea
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Chamorro CI, Wu HY, Fossum M. What the editors are reading - Section of basic science. J Pediatr Urol 2023:S1477-5131(23)00138-9. [PMID: 37183083 DOI: 10.1016/j.jpurol.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 04/11/2023] [Indexed: 05/16/2023]
Affiliation(s)
- Clara I Chamorro
- Department of Women's and Children's Health, Karolinska Institutet, Sweden
| | - Hsi-Yang Wu
- Section of Pediatric Urology, Hasbro Children's Hospital, Alpert Medical School at Brown University, USA
| | - Magdalena Fossum
- Department of Women's and Children's Health, Karolinska Institutet, Sweden; Department of Pediatric Surgery, Rigshospitalet and Department of Health Sciences, Copenhagen University, Denmark.
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Comparative early histologic healing quality of magnetic versus stapled small bowel anastomosis. Surgery 2023; 173:1060-1065. [PMID: 36566103 DOI: 10.1016/j.surg.2022.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 11/15/2022] [Accepted: 11/21/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Successful anastomotic healing is critical to preventing complications after intestinal surgery. We aimed to compare the early healing of end-to-end small bowel anastomosis by self-forming magnets with surgical stapling in a porcine model. METHOD Six Yorkshire pigs underwent 2 simultaneous small bowel anastomoses using a circular stapler and self-forming magnet technique. The primary outcome was healing quality, measured by 4 histologic features: inflammatory cell infiltration, collagen formation, grade of inflammation, and bacterial infiltration at the anastomosis. The samples were evaluated at days 1, 3, and 7. Gross evaluation of anastomotic integrity was a secondary outcome. RESULTS The self-forming magnet group displayed significant differences at each time point. On day 1, the stapled group displayed dense inflammatory cell infiltration and extensively ulcerated intestinal layers with significant edema. The self-forming magnet group showed less inflammatory infiltrate, and all intestinal layers remained compressed in direct apposition. By day 3, the self-forming magnet group already exhibited neovascularization with scant bacterial colonies. By contrast, stapled anastomoses had large areas of inflammation separating collagen fibers with prevalent bacterial infiltrations. On day 7, self-forming magnet anastomoses were characterized by robust neovascularization, maturing granulation tissue, and mucosal re-epithelization without significant inflammation. Meanwhile, stapled samples had persisting dense inflammation, tissue cavities with hemorrhage, and immature fibrous tissue. Grossly, the self-forming magnet created a patent lumen without defect, whereas stapled anastomoses demonstrated focal areas of serosal separation. CONCLUSION Bowel anastomosis by self-forming magnets is associated with superior early histologic healing metrics, including early seal generation through mechanical compression, decreased inflammation, early neovascularization, lower bacterial infiltration, and faster re-epithelization.
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Moroi R, Shiga H, Nochioka K, Chiba H, Shimoyama Y, Kuroha M, Tosa M, Kakuta Y, Kayaba S, Takahashi S, Kinouchi Y, Masamune A. Endoscopic radial incision and cutting for benign stenosis of the lower gastrointestinal tract: An investigation of novel endoscopic treatment in multicenter trial. J Gastroenterol Hepatol 2022; 37:1554-1560. [PMID: 35506307 DOI: 10.1111/jgh.15882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/11/2022] [Accepted: 04/30/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM The standard therapies for benign gastrointestinal stenosis are endoscopic balloon dilation or surgery; each have their advantages and disadvantages. In contrast, radial incision and cutting (RIC) is a novel approach for such stenosis. This study aimed to investigate the feasibility, safety, and effectiveness of RIC. METHODS We enrolled 20 patients with benign stenosis of the lower gastrointestinal tract developed by various causes and conducted RIC. We evaluated the re-intervention free rate 52 weeks after RIC, technical success rate, adverse events, procedure time, and improvement of symptoms using a visual analog scale. RESULTS We performed 20 sessions of first RIC for 20 lesions and seven sessions of additional RIC due to re-stenosis. The cumulative re-intervention-free survival rate 52 weeks after the first RIC was 55.8%. The technical success rate of the first RIC was 100% (20/20) while that of the additional RIC was 85.7% (6/7). One case developed perforation during the additional RIC and urgent surgery was performed. The additional RIC tended to show worse results in adverse events and procedure time compared with the first RIC. The patients' symptoms including abdominal bloating and dyschezia were significantly improved. CONCLUSIONS Although RIC demonstrated a higher technical success rate for lower gastrointestinal stricture and subsequent improvement of patient symptoms, several issues including preventing delayed bleeding, perforation, and the long-term prognosis should be solved and clarified in further investigations.
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Affiliation(s)
- Rintaro Moroi
- Division of Gastroenterology, Tohoku University Hospital, Sendai, Japan
| | - Hisashi Shiga
- Division of Gastroenterology, Tohoku University Hospital, Sendai, Japan
| | - Kotaro Nochioka
- Clinical Research, Innovation and Education Center, Tohoku University Hospital, Sendai, Japan
| | - Hirofumi Chiba
- Division of Gastroenterology, Iwate Prefectural Isawa Hospital, Oshu, Japan
| | - Yusuke Shimoyama
- Division of Gastroenterology, Tohoku University Hospital, Sendai, Japan
| | - Masatake Kuroha
- Division of Gastroenterology, Tohoku University Hospital, Sendai, Japan
| | - Masaki Tosa
- Division of Gastroenterology, Iwaki City Medical center, Iwaki, Japan
| | - Yoichi Kakuta
- Division of Gastroenterology, Tohoku University Hospital, Sendai, Japan
| | - Shoichi Kayaba
- Division of Gastroenterology, Iwate Prefectural Isawa Hospital, Oshu, Japan
| | - Seiichi Takahashi
- Division of Gastroenterology, Iwaki City Medical center, Iwaki, Japan
| | | | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Hospital, Sendai, Japan
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Moroi R, Shiga H, Nochioka K, Shimoyama Y, Kuroha M, Kakuta Y, Kinouchi Y, Masamune A. A pilot study investigating the safety and feasibility of endoscopic dilation using a radial incision and cutting technique for benign strictures of the small intestine: a study protocol. Pilot Feasibility Stud 2022; 8:85. [PMID: 35440064 PMCID: PMC9017048 DOI: 10.1186/s40814-022-01046-8] [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: 03/05/2021] [Accepted: 04/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background Small benign intestinal stenosis is usually treated by endoscopic balloon dilation (EBD) or surgery. Although EBD and surgery are able to resolve the stenosis in most cases, they are associated with several problems such as insufficient dilation and surgical stress, respectively. On the contrary, a novel approach called radial incision and cutting (RIC) is reported to have several benefits when compared to EBD and surgery. We can currently adopt RIC only for the strictures in the colon or terminal ileum and not for those stenotic lesions present further in the small intestine where balloon-assisted endoscopy is utilized, because the long-type electric knife is currently not approved for use in Japan. We will herein conduct a pilot study to investigate the safety and feasibility of RIC for treating the benign stenoses of the small intestine using the long-type electric knife. Methods This will be a single-center, single-arm, interventional trial. The major criteria for inclusion will be age ranging from 20 to 80 years and the presence of benign stenosis in the small intestine. We will perform RIC on 10 participants. The primary outcome is the safety of this procedure, which will be assessed by measuring the frequency of adverse events of special interest. The secondary outcomes will be technical success rate, improvement in subjective symptoms, procedure time, and duration of hospitalization. Discussion This pilot study will provide useful information that will aid in adopting RIC for treating the benign strictures present in the small intestine. Trial registration jRCT Identifier, jRCTs022200040. Registered on 1 March 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01046-8.
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Affiliation(s)
- Rintaro Moroi
- Division of Gastroenterology, Tohoku University Hospital, 1-1, Seiryo, Aoba, Sendai, Miyagi, 980-8574, Japan.
| | - Hisashi Shiga
- Division of Gastroenterology, Tohoku University Hospital, 1-1, Seiryo, Aoba, Sendai, Miyagi, 980-8574, Japan
| | - Kotaro Nochioka
- Clinical Research, Innovation and Education Center, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Yusuke Shimoyama
- Division of Gastroenterology, Tohoku University Hospital, 1-1, Seiryo, Aoba, Sendai, Miyagi, 980-8574, Japan
| | - Masatake Kuroha
- Division of Gastroenterology, Tohoku University Hospital, 1-1, Seiryo, Aoba, Sendai, Miyagi, 980-8574, Japan
| | - Yoichi Kakuta
- Division of Gastroenterology, Tohoku University Hospital, 1-1, Seiryo, Aoba, Sendai, Miyagi, 980-8574, Japan
| | - Yoshitaka Kinouchi
- Division of Gastroenterology, Tohoku University Hospital, 1-1, Seiryo, Aoba, Sendai, Miyagi, 980-8574, Japan
| | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Hospital, 1-1, Seiryo, Aoba, Sendai, Miyagi, 980-8574, Japan
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Kingo PS, Wrist Lam G, Jensen JB. Can maneuverability in the robot assisted laparoscopic stapler during ileoileal anastomosis compensate for shorter stapler length? - A randomized experimental porcine study. Scand J Urol 2021; 55:474-479. [PMID: 34553676 DOI: 10.1080/21681805.2021.1977846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Ileal anastomosis is imperative in patients given a urinary diversion during radical cystectomy. Proper handling and staplers with a certain length are important to prevent stenosis of the bowel. The study aim was to compare the circumference and diameter of ileoileal anastomoses using the Endo GIA tri-stapler 45 mm and 60 mm iDrive systems compared to the RAL Endowrist DaVinci 45 mm. This was to investigate if the better maneuverability of the robotic stapler would compensate for the shorter stapler length in the RAL Endowrist DaVinci 45. MATERIALS AND METHODS Twenty ileoileal anastomoses were performed in a total of three pigs after randomization according to the type of anastomosis technique used (depending on stapler and robotic system) allocated to four groups (each with five anastomoses): (1) iDrive 45 mm, (2) iDrive 60 mm, (3) RAL DaVinci 45 mm (Si-system), and (4) RAL DaVinci 45 mm (Xi-system). Diameter (mm) and circumference (mm) were measured and compared. RESULTS Diameters and circumferences in Group 1 were significantly smaller compared to all the other groups, which did not differ from each other, except in Group 2 where anastomoses had a significantly higher circumference than Group 4. CONCLUSION The iDrive 60 mm makes the anastomoses with the widest diameter and highest circumference compared to the iDrive 45 mm. With the RAL DaVinci 45 mm, the diameter and circumference were comparable to the iDrive 60 mm and significantly better than the iDrive 45 mm. An explanation may be the better maneuverability and surgeon control of the RAL DaVinci stapler.
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Affiliation(s)
- Pernille Skjold Kingo
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Gitte Wrist Lam
- Department of Urology, Herlev University Hospital, Herlev, Denmark
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Wu L, Li X, Li P, Pan L, Ji Z, Feng Y, Shi C. Bioabsorbable flexible elastomer of
PTMC‐b‐PEG‐b‐PTMC
copolymer as intestinal anastomosis scaffold. POLYM ADVAN TECHNOL 2021. [DOI: 10.1002/pat.5371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Lei Wu
- School of Chemical Engineering and Technology Tianjin University Tianjin China
- Wenzhou Institute of Biomaterials and Engineering, Wenzhou Institute University of Chinese Academy of Sciences Wenzhou Zhejiang China
| | - Xujian Li
- Wenzhou Institute of Biomaterials and Engineering, Wenzhou Institute University of Chinese Academy of Sciences Wenzhou Zhejiang China
| | - Pengpeng Li
- School of Biomedical Engineering Wenzhou Medical University Wenzhou Zhejiang China
| | - Luqi Pan
- Wenzhou Institute of Biomaterials and Engineering, Wenzhou Institute University of Chinese Academy of Sciences Wenzhou Zhejiang China
| | - Zhixiao Ji
- Wenzhou Institute of Biomaterials and Engineering, Wenzhou Institute University of Chinese Academy of Sciences Wenzhou Zhejiang China
| | - Yakai Feng
- School of Chemical Engineering and Technology Tianjin University Tianjin China
- Key Laboratory of Systems Bioengineering (Ministry of Education) Tianjin University Tianjin China
| | - Changcan Shi
- Wenzhou Institute of Biomaterials and Engineering, Wenzhou Institute University of Chinese Academy of Sciences Wenzhou Zhejiang China
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Balogun O, Jeje E, Atoyebi O. Training trends and practice pattern of intestinal anastomosis among Nigerian Postgraduate Trainees: A cross-sectional survey. JOURNAL OF CLINICAL SCIENCES 2021. [DOI: 10.4103/jcls.jcls_2_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ren Y, Li X, Wu L, Pan L, Ji Z, Shi C, Zhang X. Poly(trimethylene carbonate) flexible intestinal anastomosis scaffolds to reduce the probability of intestinal fistula and obstruction. J Mater Chem B 2021; 9:5340-5351. [PMID: 34152354 DOI: 10.1039/d1tb00759a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Biodegradable anastomat play an important role in the reconstruction process of the digestive tract. However, the biocompatibility and organizational compliance of anastomotic tubes still need to be improved. Electrospun tissue engineering scaffolds have excellent biomimetic extracellular matrix properties, biocompatibility and biodegradability. In the present study, electrospun poly(trimethylene carbonate) (PTMC) intestinal anastomosis scaffolds loaded with triclosan (TCS) were reported to reduce the probability of intestinal fistula and obstruction. When the viscosity average molecular weight of PTMC was 157 × 103, the elastic modulus and tensile strength of the anastomosis scaffolds could reach 20.11 MPa and 16.08 MPa, respectively, which indicated that the anastomosis scaffolds exhibited excellent tensile flexibility. The degradation of PTMC was accelerated with the increase of Mw. After 28 days, the weight and length of the anastomosis scaffolds reduced 40% and 50%, respectively. Furthermore, the application of PTMC anastomosis scaffolds could promote intestinal healing and reduce the probability of intestinal fistula and obstruction.
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Affiliation(s)
- Yuehan Ren
- Department of Colorectal anal surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P. R. China.
| | - Xujian Li
- Wenzhou Institute of Biomaterials and Engineering, Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, Zhejiang 325011, China and Oujiang Laboratory, Wenzhou, Zhejiang 325011, China.
| | - Lei Wu
- School of Chemical Engineering and Technology, Tianjin University, Tianjin 300350, China
| | - Luqi Pan
- Wenzhou Institute of Biomaterials and Engineering, Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, Zhejiang 325011, China and Oujiang Laboratory, Wenzhou, Zhejiang 325011, China.
| | - Zhixiao Ji
- Wenzhou Institute of Biomaterials and Engineering, Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, Zhejiang 325011, China and Oujiang Laboratory, Wenzhou, Zhejiang 325011, China.
| | - Changcan Shi
- Department of Colorectal anal surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P. R. China. and Wenzhou Institute of Biomaterials and Engineering, Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, Zhejiang 325011, China and Oujiang Laboratory, Wenzhou, Zhejiang 325011, China.
| | - Xiaodong Zhang
- Department of Colorectal anal surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P. R. China.
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Vogel P, Vogel DHV. Cognition errors in the treatment course of patients with anastomotic failure after colorectal resection. Patient Saf Surg 2019; 13:4. [PMID: 30679957 PMCID: PMC6343256 DOI: 10.1186/s13037-019-0184-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 01/07/2019] [Indexed: 01/02/2023] Open
Abstract
Background Cognitive errors have a considerable effect on procedural outcome. They play a major role in situational judgement and decision making, especially during cognitively demanding tasks. As such they need to be considered an important factor in medical and surgical procedures. However, whereas cognitive diagnostic errors are well known, as of yet the occurrence of errors due to cognitive heuristics may have been downplayed, underestimated, or simply been ignored during the course of surgical treatment. Methods All colorectal resections with anastomosis in 2015 and 2016 (n = 230) were prospectively screened for anastomotic failure (n = 17/230). During structured Morbidity and Mortality Conferences (MMC) all anastomotic failures were analyzed for both tactical and technical decisions in the pre- and intraoperative setting with potential meaning for the postoperative course, based on the London Protocol. In order to demonstrate the significance of cognitive errors in surgical procedures a structured interview with the individual surgeon was conducted including the video and photo documentation of the individual surgical procedure. The interviews were coded by independent coders who were instructed to identify defined cognitive errors. Inter-coder agreement was calculated using Krippendorff’s alpha. Results In 12/17 patients with anastomotic failure after colorectal surgery tactical or technical decisions with potential negative influence on anastomotic healing or the postoperative course were assessed during MMC. In 8/12 procedures a structured interview could be conducted with the operating surgeon. In 7/8 procedures cognitive errors could be identified. In particular we found Anchoring (n = 1), Availability Bias (n = 1), Commission Bias (n = 1), Overconfidence Bias (n = 1), Omission Bias (n = 2) and Sunk Costs (n = 1). Conclusion Cognitive errors seem to play an important role during surgical therapy of patients with anastomotic failure after colorectal resection. Consequently, we suggest cognitive errors should attract more interest in research as well as attention in clinical practice.
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Affiliation(s)
- P Vogel
- Abt. Allgemein-Viszeral- und Minimalinvasive Chirurgie, Klinikum Bad Hersfeld, Seilerweg 29, 36251 Bad Hersfeld, Germany.,2Klinik und Poliklinik für Chirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - D H V Vogel
- 3Uniklinik Köln, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Kerpener Straße 62, 50937 Köln, Germany
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Vachev AN, Koryttsev VK, Shcherbatenko VY, Skupchenko SV. [Peritonitis aggressiveness assessment]. Khirurgiia (Mosk) 2018:31-34. [PMID: 30531750 DOI: 10.17116/hirurgia201811131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Peritonitis due to perforated duodenal ulcer was taken as a model. Patients were conditionally divided into three groups depending on the time after perforation: 6-12, 13-24 and over 24 hours. Analysis of microflora and pH of abdominal exudate was performed immediately after laparotomy. AIM: simple and reproducible method for determining the aggressiveness of peritonitis was developed. The authors believe that the diagnostic test is useful to individualize surgical approach in patient with advanced. peritonitis regardless time after perforation.
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Affiliation(s)
- A N Vachev
- Samara State Medical University, Chair of Faculty-based Surgery, Samara, Russia
| | - V K Koryttsev
- Samara State Medical University, Chair of Faculty-based Surgery, Samara, Russia
| | | | - S V Skupchenko
- Pirogov Samara City Clinical Hospital #1, Samara, Russia
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Peng F, Liu S, Hu Y, Yu M, Chen J, Liu C. Influence of perioperative nonsteroidal anti-inflammatory drugs on complications after gastrointestinal surgery: A meta-analysis. ACTA ACUST UNITED AC 2017; 54:121-128. [PMID: 28089636 DOI: 10.1016/j.aat.2016.11.002] [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: 07/29/2016] [Revised: 11/18/2016] [Accepted: 11/21/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Nonsteroidal anti-inflammatory drugs (NSAIDs) are a key part of multimodal perioperative analgesia. This study aimed to evaluate the influence of perioperative NSAIDs application on complications after gastrointestinal surgery by using meta-analysis. METHODS A systematic review of published literature was conducted by searching computerized databases including PubMed, CBM, Springer, Chinese Academic Journals, and China Info since the databases were published until June 2015. The articles and retrospective references regarding complications after gastrointestinal surgery were collected to compare postoperative complications associated with NSAIDs or other analgesics. After they were assessed by randomized controlled trials and extracted by the standard of the Jadad systematic review, the homogeneous studies were pooled using RevMan 5.3 software. The meta-analysis was performed on five postoperative complications: postoperative anastomotic leak, cardiovascular events, surgical site infection, nausea and vomiting, and intestinal obstruction. RESULTS Twelve randomized controlled trials involving 3829 patients met the inclusion criteria. The results of meta-analyses showed the following: (1) postoperative anastomotic leak: NSAIDs (including selective and nonselective NSAIDs) increased the incidence of anastomotic leak [odds ratio (OR)=3.02, 95% confidence interval (CI): 2.16-4.23, p=0.00001]. Further results showed that nonselective NSAIDs significantly increased the incidence of anastomotic leak (OR=2.96, 95% CI: 1.99-4.42, p<0.00001), and selective NSAIDs had no significant difference as compared with the control group using other analgesics (OR=2.27, 95% CI: 0.68-7.56, p=0.18); (2) postoperative cardiovascular events: NSAIDs (selective and nonselective NSAIDs) had no difference when compared with other analgesics (OR=0.50, 95% CI: 0.23-1.12, p=0.09); (3) postoperative surgical site infection: NSAIDs (selective and nonselective NSAIDs) and other analgesics had no difference in surgical site infection (OR=0.77, 95% CI: 0.52-1.15, p=0.20); (4) postoperative nausea and vomiting: NSAIDs (selective and nonselective NSAIDs) decreased the incidence of nausea and vomiting (OR=0.53, 95% CI: 0.34-0.81, p=0.003); (5) postoperative intestinal obstruction: NSAIDs (selective and nonselective NSAIDs) decreased the incidence of intestinal obstruction (OR=0.35, 95% CI: 0.13-0.89, p=0.03). CONCLUSIONS The meta-analysis suggests that postoperative NSAIDs, especially nonselective NSAIDs, could increase the incidence of anastomotic leak. NSAIDs could decrease postoperative nausea and vomiting and intestinal obstruction, but showed no difference in cardiovascular events and surgical site infection as compared with other analgesics.
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Affiliation(s)
- Fang Peng
- Department of Anesthesiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China; Department of Anesthesiology, Northern Jiangsu People's Hospital, Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu, China
| | - Shijiang Liu
- Department of Anesthesiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Youli Hu
- Department of Anesthesiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Min Yu
- Department of Anesthesiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jing Chen
- Department of Anesthesiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Cunming Liu
- Department of Anesthesiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
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Mukherjee K, Kavalukas SL, Barbul A. Nutritional Aspects of Gastrointestinal Wound Healing. Adv Wound Care (New Rochelle) 2016; 5:507-515. [PMID: 27867755 DOI: 10.1089/wound.2015.0671] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 09/23/2015] [Indexed: 02/07/2023] Open
Abstract
Significance: Although the wound healing cascade is similar in many tissues, in the gastrointestinal tract mucosal healing is critical for processes such as inflammatory bowel disease and ulcers and healing of the mucosa, submucosa, and serosal layers is needed for surgical anastomoses and for enterocutaneous fistula. Failure of wound healing can result in complications including infection, prolonged hospitalization, critical illness, organ failure, readmission, new or worsening enterocutaneous fistula, and even death. Recent Advances: Recent advances are relevant for the role of specific micronutrients, such as vitamin D, trace elements, and the interplay between molecules with pro- and antioxidant properties. Our understanding of the role of other small molecules, genes, proteins, and macronutrients is also rapidly changing. Recent work has elucidated relationships between oxidative stress, nutritional supplementation, and glucose metabolism. Thresholds have also been established to define adequate preoperative nutritional status. Critical Issues: Further work is needed to establish standards and definitions for measuring the extent of wound healing, particularly for inflammatory bowel disease and ulcers. In addition, a mounting body of evidence has determined the need for adequate preoperative nutritional supplementation for elective surgical procedures. Future Directions: A large portion of current work is restricted to model systems in rodents. Therefore, additional clinical and translational research is needed in this area to promote gastrointestinal wound healing in humans, particularly those suffering from critical illness, patients with enterocutaneous fistula, inflammatory bowel disease, and ulcers, and those undergoing surgical procedures.
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Affiliation(s)
- Kaushik Mukherjee
- Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sandra L. Kavalukas
- Department of General Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Adrian Barbul
- Department of General Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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16
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Guyton KL, Hyman NH, Alverdy JC. Prevention of Perioperative Anastomotic Healing Complications: Anastomotic Stricture and Anastomotic Leak. Adv Surg 2016; 50:129-41. [PMID: 27520868 PMCID: PMC5079140 DOI: 10.1016/j.yasu.2016.03.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
The anastomotic healing complications of postoperative leak and stricture continue to plague surgeons despite many broadly targeted interventions. Evaluation of preventive measure efficacy is difficult due to inconsistent definitions and reporting of these complications. Few interventions have been shown to impact rates of leakage or stricture. However, new evidence is emerging that the intestinal microbiota can play an important role in the development of anastomotic complications. A more holistic approach to understanding the mechanisms of anastomotic complications is needed in order to develop tailored interventions to reduce their frequency. Such an approach may require a more complete definition of the role of the microbiota in anastomotic healing.
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Affiliation(s)
- Kristina L Guyton
- Department of Surgery, The University of Chicago Medicine, University of Chicago, 5841 South Maryland Avenue, MC 5095, Chicago, IL 60637, USA
| | - Neil H Hyman
- Department of Surgery, The University of Chicago Medicine, University of Chicago, 5841 South Maryland Avenue, MC 5095, Chicago, IL 60637, USA
| | - John C Alverdy
- Department of Surgery, The University of Chicago Medicine, University of Chicago, 5841 South Maryland Avenue, MC 5095, Chicago, IL 60637, USA.
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Marano L, Di Martino N. Efficacy of Human Fibrinogen-Thrombin Patch (TachoSil) Clinical Application in Upper Gastrointestinal Cancer Surgery. J INVEST SURG 2016; 29:352-358. [PMID: 27191688 DOI: 10.1080/08941939.2016.1181229] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Previous studies investigated the efficacy and applicability of tissue adhesives in gastrointestinal surgery while no evidence is available to date about a novel compound, TachoSil (Takeda, Zurich, Switzerland). The primary aim of this observational study was to assess the effect of new fibrin sealant on the incidence of postoperative complications in a homogeneous group of patients submitted to upper gastrointestinal surgery for cancer. METHODS Two cohorts of 28 and 34 patients undergoing upper gastrointestinal for surgery were compared. In the first cohort, the anastomotic site was treated with TachoSil fibrinogen-thrombin-collagen patches and in the second no collagen sponge or any other hemostatic sealant was used. Postoperative complications and outcomes as well as postoperative biochemical parameters were analyzed. RESULTS Postoperative complications occurred in 12 patients (35.3%) and 2 patients (7.1%) in control and collagen sponge group respectively (χ2 = 3.539, p < 0.05), with no anastomotic leakage in the collagen sponge group. A binary logistic regression analysis showed that the nonuse of collagen sponge [odds ratio (OR) = 0.025, 95% confidence interval (CI) = 0.001-0.457, p = 0.01] was independently associated with postoperative complication occurrence. CONCLUSIONS The addition of fibrinogen-thrombin-collagen sponge patch may reduce postoperative complication rate after upper gastrointestinal surgery for cancer. Further study to delineate the role of TachoSil in gastrointestinal surgery are also needed to demonstrate improved effectiveness and applicability.
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Affiliation(s)
- Luigi Marano
- a 8th General and Gastrointestinal Surgery -Department of Internal Medicine, Surgical , Neurological Metabolic Disease and Geriatric Medicine - Second University of Naples , Naples , Italy
| | - Natale Di Martino
- a 8th General and Gastrointestinal Surgery -Department of Internal Medicine, Surgical , Neurological Metabolic Disease and Geriatric Medicine - Second University of Naples , Naples , Italy
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18
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Morimoto M, Koinuma K, Lefor AK, Horie H, Ito H, Sata N, Hayashi Y, Sunada K, Yamamoto H. Diagnosis of a submucosal mass at the staple line after sigmoid colon cancer resection by endoscopic cutting-mucosa biopsy. World J Gastrointest Endosc 2016; 8:374-377. [PMID: 27114752 PMCID: PMC4835666 DOI: 10.4253/wjge.v8.i8.374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 12/18/2015] [Accepted: 02/16/2016] [Indexed: 02/05/2023] Open
Abstract
A 48-year-old man underwent laparoscopic sigmoid colon resection for cancer and surveillance colonoscopy was performed annually thereafter. Five years after the resection, a submucosal mass was found at the anastomotic staple line, 15 cm from the anal verge. Computed tomography scan and endoscopic ultrasound were not consistent with tumor recurrence. Endoscopic mucosa biopsy was performed to obtain a definitive diagnosis. Mucosal incision over the lesion with the cutting needle knife technique revealed a creamy white material, which was completely removed. Histologic examination showed fibrotic tissue without caseous necrosis or tumor cells. No bacteria, including mycobacterium, were found on culture. The patient remains free of recurrence at five years since the resection. Endoscopic biopsy with a cutting mucosal incision is an important technique for evaluation of submucosal lesions after rectal resection.
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Affiliation(s)
- Munazza Anis
- Department of Radiology, Hunter Holmes McGuire VA Hospital, Richmond, VA.
| | - Dina Caroline
- Department of Radiology, Temple University, Philadelphia, PA
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Abstract
The correct suture technique for anastomoses of the gastrointestinal (GI) tract is a major task in the daily practice of surgery and a basic requirement for a successful operation. This article provides an overview of the surgical principles and techniques involved in the creation of intestinal anastomoses, including the differentiated use of various suturing aids in the GI tract. Hand sewn and stapled anastomotic techniques are illustrated and discussed. The ongoing discussion and question as to which technique is best for GI anastomoses remains unanswered as there is no obligatory standard, even though the requirements are well defined. An ideal anastomosis should fulfil the following criteria: it must be well vascularized, safe, tension-free and spillage from the operation field should be avoided.
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Histopathologic advantages of compression ring anastomosis healing as compared with stapled anastomosis in a porcine model: a blinded comparative study. Dis Colon Rectum 2014; 57:506-13. [PMID: 24608308 DOI: 10.1097/dcr.0000000000000009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The performances of compression and stapled devices were compared previously in porcine colorectal anastomosis. The compression anastomosis was associated with elevated bursting strength and anastomotic patency in this model as compared with the stapled anastomosis. OBJECTIVE The purpose of this work was to compare the histopathologic features between compression and stapled methods in the healing of colorectal anastomoses using a porcine model. DESIGN This was a blinded comparison study. SETTINGS The study was conducted at a single university surgery department. PATIENTS Fifty crossbred pigs were used in this study. MAIN OUTCOME MEASURES Fifty crossbred pigs underwent rectal transection 20 cm from the anal verge and end-to-end compression or stapled anastomosis. The anastomotic tissues were harvested 3, 7, 30, and 90 days postoperatively (n = 5-6). Tissue repair parameters associated with the wound healing were analyzed using image analysis morphometry and histological architecture assessments. RESULTS A different microscopic pattern of the anastomotic area was shown between groups. Foreign body response was rated (p < 0.001) as minimal in the compression and moderate in the stapled group. The scarring area in the compression anastomosis group, on postoperative day 90 (4 ± 3 × 10(5) μm) was lower (p = 0.016) than in the stapled group (2 ± 1 × 10(6) μm). In addition, the anastomotic line was narrower (p = 0.003) 90 days after surgery in the compression samples (0.77 ± 0.20 mm) compared with that in the stapled group (1.86 ± 0.19 mm). Lastly, in terms of inflammatory cells, the compression biopsies showed lower (p < 0.001) numbers of mononuclear cells, polymorphonuclear cells, and lymphocytes in the anastomotic tissues 30 and 90 days from surgery. LIMITATIONS The long-term effect of the compression technique on the anastomotic patency in colorectal anastomoses should be further investigated in human studies. CONCLUSIONS Compression anastomotic healing was associated with less foreign body reactions, scarring, and inflammation as compared with stapled anastomoses in a large animal model.
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22
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Vakalopoulos KA, Daams F, Wu Z, Timmermans L, Jeekel JJ, Kleinrensink GJ, van der Ham A, Lange JF. Tissue adhesives in gastrointestinal anastomosis: a systematic review. J Surg Res 2013; 180:290-300. [PMID: 23384970 DOI: 10.1016/j.jss.2012.12.043] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 11/24/2012] [Accepted: 12/20/2012] [Indexed: 12/15/2022]
Abstract
BACKGROUND Anastomotic leakage in gastrointestinal (GI) surgery remains a major problem. Although numerous studies have been undertaken on the role of tissue adhesives as GI anastomotic sealants, no clear overview has been presented. This systematic review aims to provide a clear overview of recent experimental and clinical research on the sealing of different levels of GI anastomosis with tissue adhesives. METHODS We searched MEDLINE and Embase databases for clinical and experimental articles published after 2000. We included articles only if these addressed a tissue adhesive applied around a GI anastomosis to prevent anastomotic leakage or decrease leakage-related complications. We categorized results according to level of anastomosis, category of tissue adhesive, and level of evidence. RESULTS We included 48 studies: three on esophageal anastomosis, 13 on gastric anastomosis, four on pancreatic anastomosis, eight on small intestinal anastomosis, and 20 on colorectal anastomosis; 15 of the studies were on humans. CONCLUSIONS Research on ileal and gastric/bariatric anastomosis reveals promising results for fibrin glue sealing for specific clinical indications. Sealing of pancreatico-enteric anastomosis does not seem to be useful for high-risk patients; however, research in this field is limited. Ileal anastomotic sealing was promising in every included study, and calls for clinical evaluation. For colorectal anastomoses, sealing with fibrin glue sealing seems to have more positive results than with cyanoacrylate. Further research should concentrate on the clinical evaluation of promising experimental results as well as on new types of tissue adhesives. This research field would benefit from a systematic experimental approach with comparable methodology.
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Liu K, Yu H, Zhang M, Yu Y, Wang Y, Cai X. Sutureless primary repair of colonic perforation with a degradable stent in a porcine model of fecal peritonitis. Int J Colorectal Dis 2012; 27:1607-17. [PMID: 22664946 DOI: 10.1007/s00384-012-1511-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2012] [Indexed: 02/04/2023]
Abstract
PURPOSE Colonic perforation with fecal peritonitis is a life-threatening clinical condition. For these patients, a two-stage operation of fecal diversion and a postponed colostomy closure is generally recommended. Accordingly, a simple and feasible primary repair technique was explored. METHODS A sutureless banding method using a biodegradable stent and a porcine model of artificial colonic perforation were introduced. The colonic perforation model was created successfully with an open procedure in 34 pigs. The primary repair with a stent or the conventional hand-sewn control was performed 72 h later. Morbidity and mortality were recorded. Pigs in each group were also sacrificed to evaluate the healing on postoperative days (PODs) 3, 7, 14, and 90. The peripheral white blood cell counts, albumin, anastomotic bursting pressure, hydroxyproline contents, and histology data were evaluated. RESULTS There were 17 pigs in either group. Four pigs (23.5 %) of the control group died, but no mortality occurred in the stent group. There were no significant differences in white blood cell counts and albumin. Though anastomotic hydroxyproline contents between the two groups were comparable, the collagen per protein ratio on POD 14 in the stent group was higher, as well as the bursting pressure on PODs 3 and 7. Microscopically, the local inflammation of the cut edges in the control group was more severe, and the collagen synthesis started later. CONCLUSIONS A sutureless primary repair of a colonic perforation with a degradable stent is a feasible method in a porcine model of fecal peritonitis.
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Affiliation(s)
- Kun Liu
- Department of Hepatobiliary Surgery, Qingdao Municipal Hospital, Ocean University of China, Qingdao, China
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Terrone DG, Lepanto L, Billiard JS, Olivié D, Murphy-Lavallée J, Vandenbroucke F, Tang A. A primer to common major gastrointestinal post-surgical anatomy on CT-a pictorial review. Insights Imaging 2012; 2:631-638. [PMID: 22347982 PMCID: PMC3259310 DOI: 10.1007/s13244-011-0121-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 07/02/2011] [Accepted: 07/13/2011] [Indexed: 12/01/2022] Open
Abstract
The post-operative abdomen can be challenging and knowledge of normal post-operative anatomy is important for diagnosing complications. The aim of this pictorial essay is to describe a few selected common, major gastrointestinal surgeries, their clinical indications and depict their normal post-operative computed tomography (CT) appearance. This essay provides some clues to identify the surgeries, which can be helpful especially when surgical history is lacking: recognition of the organ(s) involved, determination of what was resected and familiarity with the type of anastomoses used.
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Affiliation(s)
- Donato Gerardo Terrone
- Department of Radiology, University of Montreal and Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Hôpital Saint-Luc, 1058 rue Saint-Denis, Montréal, QC Canada H2X 3J4
| | - Luigi Lepanto
- Department of Radiology, University of Montreal and Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Hôpital Saint-Luc, 1058 rue Saint-Denis, Montréal, QC Canada H2X 3J4
| | - Jean-Sébastien Billiard
- Department of Radiology, University of Montreal and Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Hôpital Saint-Luc, 1058 rue Saint-Denis, Montréal, QC Canada H2X 3J4
| | - Damien Olivié
- Department of Radiology, University of Montreal and Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Hôpital Saint-Luc, 1058 rue Saint-Denis, Montréal, QC Canada H2X 3J4
| | - Jessica Murphy-Lavallée
- Department of Radiology, University of Montreal and Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Hôpital Saint-Luc, 1058 rue Saint-Denis, Montréal, QC Canada H2X 3J4
| | - Franck Vandenbroucke
- Department of Surgery, University of Montreal and CRCHUM, Hôpital Saint-Luc, 1058 rue Saint-Denis, Montréal, QC Canada H2X 3J4
| | - An Tang
- Department of Radiology, University of Montreal and Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Hôpital Saint-Luc, 1058 rue Saint-Denis, Montréal, QC Canada H2X 3J4
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25
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Karaman K, Bostanci EB, Dincer N, Ulas M, Ozer I, Dalgic T, Ercin U, Bilgihan A, Ginis Z, Akoglu M. Effects of thyroid hormone supplementation on anastomotic healing after segmental colonic resection. J Surg Res 2011; 176:460-7. [PMID: 22316672 DOI: 10.1016/j.jss.2011.11.1015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2011] [Revised: 10/23/2011] [Accepted: 11/18/2011] [Indexed: 12/12/2022]
Abstract
BACKGROUND Alterations of thyroid hormones in colorectal surgery were previously studied. The aim of the present study was to determine the effects of triiodothyronine (T3) supplementation on anastomotic healing after segmental colectomy. MATERIAL AND METHODS Thirty male Wistar albino rats were divided into sham (n = 6), control (n = 12), and experimental (n = 12) groups. Sham group rats were immediately sacrificed after segmental colonic resection. Control and experimental group rats underwent resection and anastomosis. Experimental group rats received a single dose of T3 (400 μg/100 g) in postoperative day 1. Half of both control and experimental group rats were sacrificed on postoperative d 3 and the remaining half were sacrificed on postoperative d 7. Hydroxiproline (HP), myeloperoxidase (MPO), thyroid stimulating hormone (TSH), free T3 (FT3), and free thyroxine (FT4) levels, bursting pressure, and histologic analyses of the anastomotic segments were compared. RESULTS FT3 levels significantly decreased in control groups rats compared with the sham group (P < 0.01). However, T3 hormone given rats had no decline in FT3 levels. Anastomotic bursting pressure was significantly higher in the experimental group rats on postoperative d 7 (P = 0.015). Histopathologic analyses of the anastomotic segments determined significantly more severe edema and necrosis in control group rats (P < 0.05). Collagen deposition in the anastomotic tissue was significantly higher in experimental group rats on postoperative d 7 (P = 0.015). CONCLUSION Anastomosis after colon resection is associated with decreased FT3 level. T3 supplementation ameliorates the reduction in FT3 and seems to provide constructive therapeutic effects on anastomotic healing.
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Affiliation(s)
- Kerem Karaman
- Department of Gastroenterological Surgery, Turkiye Yuksek Ihtisas Teaching and Research Hospital, Ankara, Turkey.
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Rushfeldt CF, Sveinbjørnsson B, Søreide K, Vonen B. Risk of anastomotic leakage with use of NSAIDs after gastrointestinal surgery. Int J Colorectal Dis 2011; 26:1501-9. [PMID: 21833507 DOI: 10.1007/s00384-011-1285-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/22/2011] [Indexed: 02/04/2023]
Abstract
PURPOSE Analgesic regimes to avoid opioid-related adverse effects have been recommended in gastrointestinal surgery. Non-steroidal anti-inflammatory drugs (NSAIDs) are an important component of opioid sparing regimes in that these drugs indirectly reduce pain by inhibiting inflammation. Although beneficial for most surgical patients, animal studies and recent clinical studies suggest a harmful effect on new intestinal anastomoses by increasing the rate of leakage. NSAIDs may indirectly disturb anastomotic healing by inhibiting inflammation as an integrated part of the wound healing process in an early, critical phase after surgery. METHODS A literature review based on a structured search in PubMed of clinical and experimental studies investigating the effects of NSAIDs on anastomotic healing and leakage rates after intestinal surgery, as well as proposed mechanisms and effects studied in animal models. RESULTS Three recent observational cohort studies (accumulated n = 882) indicate an increased rate of anastomotic leakages (15-21%) associated with cyclooxygenase-2 (COX-2) selective NSAIDs after intestinal surgery compared to the leakage rates in controls or historical cohorts (1-4%). Three prospective studies on related topics contain relevant data on NSAIDs and are compared to these studies. Several experimental animal studies support an increased risk for anastomotic leakage with the use of NSAIDs. CONCLUSION The reported effects of NSAIDs on anastomotic healing suggest an increased risk for leakage. A better understanding of the complex interactions of NSAID-induced inhibition on anastomotic healing is a prerequisite for the safe use of NSAIDs. Until more data are available, a careful use of NSAIDs may be warranted in gastrointestinal anastomotic surgery.
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Cueto J, Barrientos T, Rodríguez E, Del Moral P. A new biodegradable adhesive for protection of intestinal anastomoses. Preliminary communication. Arch Med Res 2011; 42:475-81. [PMID: 21939702 DOI: 10.1016/j.arcmed.2011.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 08/12/2011] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND AIMS Anastomotic leaks continue to be a devastating complication for patients and surgeons worldwide. The few surgical adhesives available to date have not achieved the desired clinical results. The purpose of this experimental study was to determine if Pebisut® applied to intestinal suture lines provides increased resistance and protection during the critical days of healing. METHODS Intestinal lesions were caused in rats and dogs and a new biodegradable adhesive (Pebisut®) (patent granted in the European Union 07808494.4-1219, 01.12.2010, in Mexico P.C.T./MX/a/2009/001737, 16.02.2009, pending in the U.S.P.T.O. 60/762,136, 26.01.2006) was applied to compare the resistance of suture lines using bursting pressures and histologically. RESULTS Under acute and chronic conditions, Pebisut® strengthened and made the suture lines more resistant, while histologically penetrating and sealing them. The adhesive disappears within 2-3 weeks and is well tolerated by the intestinal tissues. CONCLUSIONS This biodegradable adhesive provides greater resistance, temporarily protects suture lines and may prevent anastomotic leaks.
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Affiliation(s)
- Jorge Cueto
- Health Sciences Faculty, Anahuac University, Bosque de Magnolias No. 87, Mexico City, Mexico.
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Abstract
Surgery of the lower gastrointestinal tract includes segmental resections for benign colorectal diseases and radical resections for treating colorectal cancer performed under elective and emergency conditions. The most important part of the surgical procedure is the reconstruction of the physiological intestinal continuity by anastomosis. At present laparoscopic surgery has widened the array of different suturing and stapling techniques. The effectiveness of manual and stapled anastomoses depends on the expertise of the surgeon. However, skillful preparation of the hand-sutured technique is essential.
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