Endo GIA stapler malfunction in a small bowel loop resection

Stapled functional end-to-end intestinal anastomosis with endovascular gastrointestinal anastomosis staplers in cats and small dogs

OBJECTIVES

To investigate the use of endovascular gastrointestinal stapling devices to perform intestinal functional end-to-end stapled anastomosis in small dogs and cats.

MATERIALS AND METHODS

Medical records of dogs (≤10 kg) and cats that underwent intestinal resection and functional end-to-end stapled anastomosis with an endovascular gastrointestinal anastomosis (endovascular-GIA) stapling device at five small animal referral centres between April 2014 and September 2023 were retrospectively reviewed. Data including clinical findings, surgical technique, histopathology and complications were collected. A minimum follow-up of 10 days was required. Patients with follow-up of less than 10 days were included if they developed a major complication. Outcome was obtained from assessing the clinical records and contacting the referring veterinarians or owners. Estimated survival was generated according to the Kaplan-Meier method. Differences between survival curves were tested by log-rank test.

RESULTS

Twenty-five patients (10 dogs and 15 cats) were included. The median bodyweight was 4.6 kg (range 2.6 to 10 kg). Nine patients were diagnosed with intestinal neoplasia, 16 with non-neoplastic intestinal disease. The median follow-up was 126 days (range 18 to 896 days). Five patients developed minor postoperative complications, including three superficial surgical site infections. No major postoperative complications were reported. Eighteen patients were alive at the end of the study, one patient was lost to follow-up. Kaplan-Meier estimated median survival time was not reached. Survival was significantly longer for patients with non-neoplastic versus neoplastic intestinal.

CLINICAL SIGNIFICANCE

The study suggests that the use of endovascular gastrointestinal anastomosis staplers is safe and effective to perform intestinal functional end-to-end stapled anastomosis in dogs ≤10 kg and cats.

Common and uncommon vascular injuries and endovascular treatment associated with pelvic blunt trauma: a real-world experience

Pelvic fractures are common in cases of blunt trauma, which is strongly associated with mortality. Transcatheter arterial embolization is a fundamental treatment strategy for fatal arterial injuries caused by blunt pelvic trauma. However, vascular injuries due to blunt pelvic trauma can show various imaging findings other than arterial hemorrhage. We present a pictorial review of common and uncommon vascular injuries, including active arterial bleeding, pseudoaneurysm, arteriovenous fistula, arterial occlusion, vasospasm, and active venous bleeding. Knowledge of these vascular injuries can help clinicians select the appropriate therapeutic strategy and thus save lives.

INTRAOPERATIVE MALFUNCTIONS OF STAPLER DEVICES. THE CURRENT STATE OF THE PROBLEM AND A SERIES OF CLINICAL CASES

The paper presents several medical device reports from our center identified during application of surgical staplers from different manufacturers. The revealed malfunction did not lead to postoperative complications, however, they affected the duration of the operation and the cost of treatment. Failure of the stapler devices during surgery in the absence of proper attention to the staple line can lead to an increase in the frequency of postoperative complications. It remains unclear the problem of «small» malfunctions of stapler devices, which may go unnoticed during surgery, but affect the outcomes of treatment of patients. In order to identify a possible association between these adverse events and postoperative complications, it is necessary to form a state register of events associated with the use of stapler devices.

Inclusion of a Clip Inside the Cartridge and Failure of the Stapler When Performing a Laparoscopic Sleeve Gastrectomy

The growth of the surgical industry and the development of surgical techniques have allowed us to achieve better results for patients. Laparoscopic staplers are a crucial tool in laparoscopic surgery, and despite their proven safety and efficiency, they have been associated with technical and mechanical failures on rare occasions. Adequate knowledge of the surgical instruments is critical to accomplishing optimal results and to adequately treating these rare malfunctions and their consequences. We present a case of a surgical stapler malfunction due to a titanium clip during laparoscopic sleeve gastrectomy. This mechanical failure produced a complication that was adequately resolved, and the patient completely recovered. Our brief communication shows that errors during sleeve gastrectomy can occur, and that precise surgical skills along with a close follow-up are crucial to improve the patient outcome when these rare complications arise.