1
|
Zhu C, Na Y, Cheng X, Tao X, Xie P, Chen L, Zhao H, Qiu J, Gu X, Xiang J, Liu K. Assessing the influence of parameters on tissue welding in small bowel end-to-end anastomosis in vitro and in vivo. Surg Endosc 2024:10.1007/s00464-024-10795-x. [PMID: 38622226 DOI: 10.1007/s00464-024-10795-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/09/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND The use of high-frequency electric welding technology for intestinal end-to-end anastomosis holds significant promise. Past studies have focused on in vitro, and the safety and efficacy of this technology is uncertain, severely limiting the clinical application of this technology. This study investigates the impact of compression pressure, energy dosage, and duration on anastomotic quality using a homemade anastomosis device in both in vitro and in vivo settings. METHODS Two hundred eighty intestines and 5 experimental pigs were used for in vitro and in vivo experiments, respectively. The in vitro experiments were conducted to study the effects of initial pressure (50-400 kpa), voltage (40-60 V), and time (10-20 s) on burst pressure, breaking strength, thermal damage, and histopathological microstructure of the anastomosis. Optimal parameters were then inlaid into a homemade anastomosis and used for in vivo experiments to study the postoperative porcine survival rate and the pathological structure of the tissues at the anastomosis and the characteristics of the collagen fibers. RESULTS The anastomotic strength was highest when the compression pressure was 250 kPa, the voltage was 60 V, and the time was 15 s. The degree of thermal damage to the surrounding tissues was the lowest. The experimental pigs had no adverse reactions after the operation, and the survival rate was 100%. 30 days after the operation, the surgical site healed well, and the tissues at the anastomosis changed from immediate adhesions to permanent connections. CONCLUSION High-frequency electric welding technology has a certain degree of safety and effectiveness. It has the potential to replace the stapler anastomosis in future and become the next generation of new anastomosis device.
Collapse
Affiliation(s)
- Caihui Zhu
- School of Information Science and Technology, Fudan University, Shanghai, China
| | - Yuyan Na
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiujun Cheng
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaonan Tao
- School of Information Science and Technology, Fudan University, Shanghai, China
| | - Pengyao Xie
- School of Information Science and Technology, Fudan University, Shanghai, China
| | - Lei Chen
- School of Information Science and Technology, Fudan University, Shanghai, China
| | - Hui Zhao
- School of Information Science and Technology, Fudan University, Shanghai, China
| | - Jian Qiu
- School of Information Science and Technology, Fudan University, Shanghai, China
| | - Xiaodong Gu
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Jianbin Xiang
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Kefu Liu
- School of Information Science and Technology, Fudan University, Shanghai, China.
| |
Collapse
|
2
|
Cope J, Greer D, Soundappan SSV, Pasupati A, Adams S. The Safety and Efficacy of Early Enteral Nutrition After Paediatric Enterostomy Closure - The EPOC Study. J Pediatr Surg 2024; 59:701-708. [PMID: 38135546 DOI: 10.1016/j.jpedsurg.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 10/27/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023]
Abstract
INTRODUCTION Keeping children nil by mouth until return of bowel function after intestinal anastomosis surgery is said to reduce complications. Fasting may extend up to five days, risking malnourishment and usage of parenteral nutrition. This study aims to establish the efficacy and safety of early enteral nutrition in children undergoing intestinal stoma closure. METHODOLOGY A retrospective cohort study of children aged three months to 16 years who underwent an intestinal stoma closure between 1/1/2019 and 31/12/2021 at two tertiary paediatric hospitals was undertaken. Children fed clear fluids within 24 h (EEN) were compared to those commencing feeds later (LEN). The primary outcome was length of post-operative stay (LOS) and secondary outcomes included: time to feeds; time to stool; and complications. RESULTS Of the 129 children that underwent a stoma closure, 69 met inclusion criteria: 35 (51 %) in the LEN group and 34 (49 %) in the EEN group. Children in the EEN group had a significantly shorter LOS (92.6 h vs 121.7 h, p = 0.0045). Early feeding was also associated with a significantly decreased time to free fluids (p < 0.001) and full enteral intake (p = 0.007). There was no significant intergroup difference in complications. CONCLUSION Commencing feeding within 24 h of stoma closure is efficacious and safe, with clear reductions in LOS, time to full feeds and time to stool, and no increase in complications. Further research is required to extrapolate these findings to other populations. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- James Cope
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, University of NSW, Kensington, NSW, 2033, Australia
| | - Douglas Greer
- Toby Bowring Department Paediatric Surgery, Sydney Children's Hospital, Randwick, NSW, 2031, Australia
| | - Soundappan S V Soundappan
- Douglas Cohen Department of Paediatric Surgery, The Children's Hospital at Westmead, Westmead, NSW, 2145, Australia; Sydney Medical School, The University of Sydney, Sydney, NSW, 2050, Australia
| | - Aneetha Pasupati
- Toby Bowring Department Paediatric Surgery, Sydney Children's Hospital, Randwick, NSW, 2031, Australia
| | - Susan Adams
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, University of NSW, Kensington, NSW, 2033, Australia; Toby Bowring Department Paediatric Surgery, Sydney Children's Hospital, Randwick, NSW, 2031, Australia.
| |
Collapse
|
3
|
Gómez Garnica DG, Rey Chaves CE, Barco-Castillo C, Gutierrez JA, Falla A. Negative Pressure Wound Therapy After Intestinal Anastomosis: A Risk Factor Analysis for Dehiscence. J Surg Res 2024; 296:223-229. [PMID: 38286101 DOI: 10.1016/j.jss.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/18/2023] [Accepted: 01/02/2024] [Indexed: 01/31/2024]
Abstract
INTRODUCTION Negative pressure wound therapy (NPWT) is part of the temporary abdominal closure in the treatment of patients with traumatic, inflammatory, or vascular disease. However, the use of NPWT when performing an intestinal anastomosis has been controversial. This study aimed to describe the patients managed with NPWT therapy and identify the risk factors for anastomotic dehiscence when intestinal anastomosis was performed. METHODS A single-center cohort study with prospectively collected databases was performed. Patients who required NPWT therapy from January 2014 to December 2018 were included. Patients were stratified according to the performance of intestinal anastomosis and according to the presence of dehiscence. Bivariate and multivariate analyses were performed for anastomotic dehiscence and mortality. RESULTS A total of 97 patients were included. Median age was 52 y old [interquartile range 24.5-70]. Male patients corresponded to 75.6% (n = 34) of the population. Delayed fascial closure was performed in 80% (n = 36). The risk of anastomotic dehiscence was higher in females (odds ratio (OR) 11.52 [confidence interval (CI) 1.29-97.85], P = 0.030), delayed fascial closure (OR 18.18 [CI 2.02-163.5], P = 0.010) and use of vasopressors (OR 12.04 [CI 1.22-118.47], P = 0.033). NPWT pressures >110 mmHg were evidenced in the dehiscence group with statistically significant value (OR 1.2 [0.99-2.26] p 0.04) CONCLUSIONS: There is still controversy in the use of NPWT when performing intestinal anastomosis. According to our data, the risk of dehiscence is higher in females, delayed fascial closure, use of vasopressors, and NPWT pressures >110 MMHG.
Collapse
Affiliation(s)
- David Guillermo Gómez Garnica
- Department of General Surgery, Hospital Militar Central, Bogotá DC, Colombia; Universidad Militar Nueva Granada School of Medicine, Bogotá DC, Colombia; Cirugía General, Profesor Asistente, Pontificia Universidad Javeriana, Facultad de Medicina, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Carlos Eduardo Rey Chaves
- Estudiante de Posgrado Cirugía General, Pontificia Universidad Javeriana, Facultad de Medicina, Bogotá, Colombia.
| | - Catalina Barco-Castillo
- Universidad Militar Nueva Granada School of Medicine, Bogotá DC, Colombia; Department of Urology, Hospital Militar Central, Bogotá DC, Colombia
| | - Jorge Andrés Gutierrez
- Department of General Surgery, Hospital Militar Central, Bogotá DC, Colombia; Universidad Militar Nueva Granada School of Medicine, Bogotá DC, Colombia; Cirugía General, Profesor Asistente, Pontificia Universidad Javeriana, Facultad de Medicina, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Andrés Falla
- Department of General Surgery, Hospital Militar Central, Bogotá DC, Colombia; Universidad Militar Nueva Granada School of Medicine, Bogotá DC, Colombia
| |
Collapse
|
4
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
5
|
Dong J, Feng C, Dang J, Yang X, Zhang T, Wang B. Preparation of healing promotive alanyl-glutamine-poly(p-dioxanone) electrospun membrane integrated with gentamycin and its application for intestinal anastomosis in rats. Biomater Adv 2022; 139:212977. [PMID: 35882134 DOI: 10.1016/j.bioadv.2022.212977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 05/23/2022] [Accepted: 06/04/2022] [Indexed: 06/15/2023]
Abstract
Anastomosis surgery at the intestinal site is performed on millions of individuals every year. However, several persistent complications, such as anastomotic leakage, abnormal adhesion, and anastomotic stenosis, have been observed after the surgery. For promoting anastomotic healing and to overcome the challenges mentioned above, re-epithelialization at anastomotic sites is crucial. In this study, an epithelialization-promoting macromolecular prodrug Ala-Gln-PPDO was prepared and processed into fibrous membranes by electrospinning. Ala-Gln and gentamicin were sustainably released from the electrospun membranes with degradation of these membranes to promote the proliferation of rat intestinal epithelial cells and suppress the proliferation of Staphylococcus aureus and Escherichia coli. The comprehensive repair effects of Ala-Gln-PPDO membranes have been evaluated in rat models of intestinal anastomosis in this study. Application of Ala-Gln-PPDO membranes, especially the gentamicin-incorporated Ala-Gln-PPDO ones, could prevent adhesion between the injured intestine and surrounding intestinal tissues. In addition, they did not affect the healing strength of anastomotic stoma negatively and could promote re-epithelialization at the anastomotic sites. Furthermore, the gentamicin-incorporated Ala-Gln-PPDO membranes could relieve stenosis at anastomotic sites. The gentamicin-incorporated Ala-Gln-PPDO electrospun membrane is a promising, comprehensive implantable material for promoting healing after gastrointestinal anastomosis owing to its effects involving the promotion of re-epithelialization, prevention of adhesion, and relieving of anastomotic stenosis.
Collapse
Affiliation(s)
- Jun Dong
- Department of Chemistry, School of Pharmacy, North Sichuan Medical College, Nanchong, China
| | - Chengmin Feng
- Department of Otolaryngology & Head and Neck Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Jiafeng Dang
- Gynecology and Obstetrics, Department of Clinical Medicine, The Third Affiliated Hospital of Chengdu Medicine College, Pidu District People's Hospital, Chengdu, China
| | - Xiaomei Yang
- Department of Clinical Medicine, North Sichuan Medical College, Nanchong, China
| | - Ting Zhang
- Department of Clinical Medicine, North Sichuan Medical College, Nanchong, China
| | - Bing Wang
- Department of Chemistry, School of Pharmacy, North Sichuan Medical College, Nanchong, China; Medical Imaging Key Laboratory of Sichuan Province, North Sichuan Medical College, Nanchong, China.
| |
Collapse
|
6
|
Mittelstädt A, von Loeffelholz T, Weber K, Denz A, Krautz C, Grützmann R, Weber GF, Brunner M. Influence of interrupted versus continuous suture technique on intestinal anastomotic leakage rate in patients with Crohn's disease - a propensity score matched analysis. Int J Colorectal Dis 2022; 37:2245-2253. [PMID: 36216902 PMCID: PMC9560923 DOI: 10.1007/s00384-022-04252-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/18/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE Intestinal anastomosis is a crucial step in most intestinal resections, as anastomotic leakage is often associated with severe consequences for affected patients. There are especially two different techniques for hand-sewn intestinal anastomosis: the interrupted suture technique (IST) and the continuous suture technique (CST). This study investigated whether one of these two suture techniques is associated with a lower rate of anastomotic leakage. METHODS A retrospective review of 332 patients with Crohn's disease who received at least one hand-sewn colonic anastomosis at our institution from 2010 to 2020 was performed. Using propensity score matching 183 patients with IST were compared to 96 patients with CST in regard to the impact of the anastomotic technique on patient outcomes. RESULTS Overall anastomotic leakage rate was 5%. Leakage rate did not differ between the suture technique groups (IST: 6% vs. CST: 3%, p = 0.393). Multivariate analysis revealed the ASA score as only independent risk factor for anastomotic leakage (OR 5.3 (95% CI = 1.2-23.2), p = 0.026). Suture technique also showed no significant influence on morbidity and the re-surgery rate in multivariate analysis. CONCLUSION Our data suggest that the chosen suture technique (interrupted vs. continuous) has no influence on postoperative outcome, especially on anastomotic leakage rate. This finding should be confirmed by a randomized controlled trial.
Collapse
Affiliation(s)
- Anke Mittelstädt
- grid.5330.50000 0001 2107 3311Department of General and Visceral Surgery, Friedrich-Alexander-University, Krankenhausstraße 12, Erlangen, Germany
| | - Tobias von Loeffelholz
- grid.5330.50000 0001 2107 3311Department of General and Visceral Surgery, Friedrich-Alexander-University, Krankenhausstraße 12, Erlangen, Germany
| | - Klaus Weber
- grid.5330.50000 0001 2107 3311Department of General and Visceral Surgery, Friedrich-Alexander-University, Krankenhausstraße 12, Erlangen, Germany
| | - Axel Denz
- grid.5330.50000 0001 2107 3311Department of General and Visceral Surgery, Friedrich-Alexander-University, Krankenhausstraße 12, Erlangen, Germany
| | - Christian Krautz
- grid.5330.50000 0001 2107 3311Department of General and Visceral Surgery, Friedrich-Alexander-University, Krankenhausstraße 12, Erlangen, Germany
| | - Robert Grützmann
- grid.5330.50000 0001 2107 3311Department of General and Visceral Surgery, Friedrich-Alexander-University, Krankenhausstraße 12, Erlangen, Germany
| | - Georg F. Weber
- grid.5330.50000 0001 2107 3311Department of General and Visceral Surgery, Friedrich-Alexander-University, Krankenhausstraße 12, Erlangen, Germany
| | - Maximilian Brunner
- grid.5330.50000 0001 2107 3311Department of General and Visceral Surgery, Friedrich-Alexander-University, Krankenhausstraße 12, Erlangen, Germany
| |
Collapse
|
7
|
Takazawa S, Nishi A, Ishimaru T, Takahashi M, Sunouchi T, Kikuchi K, Koyama R. Face and construct validity assessment of training models for intestinal anastomosis in low-birth-weight infants. Pediatr Surg Int 2021; 37:1765-72. [PMID: 34476538 DOI: 10.1007/s00383-021-04991-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE It is difficult to perform intestinal anastomosis in low-birth-weight infants because the intestinal diameter is small and the discrepancy in diameter of the proximal and distal intestines is often large, but there has been no optimal-sized training model. Therefore, we developed a new intestinal anastomosis training model that imitated the size of the intestine in low-birth-weight infants, and evaluated its face and construct validity. METHODS Two intestinal models were developed with crossMedical, Inc. using a hydrophilic acrylic material (wet model) or a polyurethane soft resin (dry model). The inner diameter of the simulated intestinal tract was 15 mm on the oral end and 6 mm on the anal end. Thirteen pediatric surgeons performed anastomosis and responded to the questionnaire. RESULTS In the questionnaire, the wet model had significantly higher scores than the dry model in "appearance", "softness" and "usefulness for training". In the anastomotic results of the wet model, the anastomosis leak pressure was significantly correlated with the number of intestinal anastomotic experiences in low-birth-weight infants (correlation coefficient = 0.64, P = 0.035). CONCLUSIONS The wet-type intestinal anastomosis model showed good face validity. Its leak pressure had a significant correlation with clinical experience; thus, construct validity was demonstrated.
Collapse
|
8
|
Martín Parra JI, Toledo Martínez E, Martínez Pérez P, Ruiz Gómez JL, Fernández Santiago R, López Useros A, Manuel Palazuelos JC, Rodríguez Sanjuán JC. Analysis of learning styles in a laparoscopic technical skills course. Implications for surgical training. Cir Esp 2021; 99:730-736. [PMID: 34772651 DOI: 10.1016/j.cireng.2021.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 11/15/2020] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Learning surgical techniques is a dynamic process. In the 1980s David Kolb described developed a learning model that enabled teaching styles to adapt for better learner outcomes. The aim of this study was to identify the Kolb learning styles of the participants in a laparoscopic technical skills course and to check see if there was any relationship with performance. METHODS An observational descriptive study was conducted with 64 participants in an intensive course in which they performed laparoscopic manual intestinal anastomoses. All completed Kolb's inventory of learning styles. For each anastomosis, join quality was assessed and the performing time recorded. After that, they were analyzed through statistical studies. RESULTS The most frequent learning style was assimilating type (39.1%). No significant differences were observed between different learning styles and gender, professional category, the time taken or the quality of the anastomoses. CONCLUSIONS Assimilating type was the most frequent Kolb learning style, with no differences observed between categories, age or gender. There is no relationship between the learning style of the participants and the results obtained in the course.
Collapse
Affiliation(s)
- José Ignacio Martín Parra
- Servicio de Cirugía General, Hospital Universitario Marqués de Valdecilla, Santander, Spain; Hospital virtual Valdecilla, Santander, Spain.
| | - Enrique Toledo Martínez
- Servicio de Cirugía General, Hospital Universitario Marqués de Valdecilla, Santander, Spain; Hospital virtual Valdecilla, Santander, Spain
| | - Paula Martínez Pérez
- Servicio de Cirugía General, Hospital Universitario Marqués de Valdecilla, Santander, Spain; Hospital virtual Valdecilla, Santander, Spain
| | - José Luis Ruiz Gómez
- Hospital virtual Valdecilla, Santander, Spain; Hospital Comarcal Sierrallana, Torrelavega, Cantabria, Spain
| | - Roberto Fernández Santiago
- Servicio de Cirugía General, Hospital Universitario Marqués de Valdecilla, Santander, Spain; Hospital virtual Valdecilla, Santander, Spain
| | - Antonio López Useros
- Servicio de Cirugía General, Hospital Universitario Marqués de Valdecilla, Santander, Spain; Hospital virtual Valdecilla, Santander, Spain
| | - José Carlos Manuel Palazuelos
- Servicio de Cirugía General, Hospital Universitario Marqués de Valdecilla, Santander, Spain; Hospital virtual Valdecilla, Santander, Spain
| | - Juan Carlos Rodríguez Sanjuán
- Servicio de Cirugía General, Hospital Universitario Marqués de Valdecilla, Santander, Spain; Hospital virtual Valdecilla, Santander, Spain
| |
Collapse
|
9
|
Chen W, Zhang Y, Qin H, Fan Z, Hu H, Chen M, Jiang C, Qian Q, Ding Z. A pilot study on prophylactic tube enterostomy for the prevention of anastomotic leakage in patients with high-risk intestinal anastomosis. Langenbecks Arch Surg 2021; 407:267-275. [PMID: 34549336 DOI: 10.1007/s00423-021-02326-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 09/03/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Anastomotic leakages (ALs) are one of the most serious complications following gastrointestinal anastomosis. Currently, very few operative measures are available for the prevention of ALs. This pilot study aimed to evaluate the safety and efficacy of tube enterostomy (T-E) for the prevention of ALs in patients with high-risk intestinal anastomosis. METHODS In this retrospective study, demographic data and postoperative outcomes were compared among patients who received T-E and two historical cohorts: one group that underwent primary anastomosis without T-E (non-T-E group) and another that underwent conventional stoma construction without anastomosis (stoma group). The operative procedures were selected according to a scoring system that quantitatively evaluated risk of Als (Zhongnan score). RESULTS From March 2017 to March 2020, a total of 45 consecutive patients were enrolled in the T-E group. Among these patients, 53.3% (24/45) were diagnosed with Crohn's disease (CD), and 66.7% (30/45) of them underwent emergency surgery. After propensity score matching, the demographic data were comparable among the three groups. One case of AL (2.2%) occurred in the T-E group, while four cases of ALs (8.9%, 4/45) were found in the non-T-E group (p = 0.13). Tube feeding was provided to 33.3% (15/45) of the T-E patients. Major tube-related complications included one tube dislocation (2.2%) and 3 (6.7%) minor leakages after tube withdrawal (treated conservatively). One death occurred in the stoma group. In the subgroup analysis of CD patients, lower rates of ALs and abdominal abscesses were observed in the T-E group than in the non-T-E and stoma subgroups, but the differences were not significant. CONCLUSIONS T-E seems to be a safe and feasible operative method for the protection of high-risk intestinal anastomosis, can be reversed and can provide enteral feeding with acceptable tube-related complications. Further studies are needed to validate the role of T-E.
Collapse
Affiliation(s)
- Wenhao Chen
- Colorectal Surgery Department, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China.,Inflammatory Bowel Diseases Center of Zhongnan Hospital, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Intestinal & Colorectal Diseases, Quality Control Center of Colorectal Surgery, Health Commission of Hubei Province, Wuhan, China
| | - Yichao Zhang
- Department of General Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Haibo Qin
- Colorectal Surgery Department, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Zhou Fan
- Colorectal Surgery Department, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Hang Hu
- Colorectal Surgery Department, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China.,Inflammatory Bowel Diseases Center of Zhongnan Hospital, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Intestinal & Colorectal Diseases, Quality Control Center of Colorectal Surgery, Health Commission of Hubei Province, Wuhan, China
| | - Min Chen
- Gastroenterology Department, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Congqing Jiang
- Colorectal Surgery Department, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China.,Hubei Key Laboratory of Intestinal & Colorectal Diseases, Quality Control Center of Colorectal Surgery, Health Commission of Hubei Province, Wuhan, China
| | - Qun Qian
- Colorectal Surgery Department, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China.,Inflammatory Bowel Diseases Center of Zhongnan Hospital, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Intestinal & Colorectal Diseases, Quality Control Center of Colorectal Surgery, Health Commission of Hubei Province, Wuhan, China
| | - Zhao Ding
- Colorectal Surgery Department, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China. .,Inflammatory Bowel Diseases Center of Zhongnan Hospital, Wuhan University, Wuhan, China. .,Hubei Key Laboratory of Intestinal & Colorectal Diseases, Quality Control Center of Colorectal Surgery, Health Commission of Hubei Province, Wuhan, China. .,Division of Colon and Rectal Surgery, Colorectal Surgery Department, Zhongnan Hospital of Wuhan University, Wuhan, China.
| |
Collapse
|
10
|
Brindle M, Heiss K. Commentary on early enteral feeding versus traditional feeding in neonatal congenital gastrointestinal malformation undergoing intestinal anastomosis: A randomized multicenter controlled trial of an enhanced recovery after surgery (ERAS) component. J Pediatr Surg 2021; 56:1485-1486. [PMID: 33858668 DOI: 10.1016/j.jpedsurg.2021.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 03/17/2021] [Indexed: 11/17/2022]
Abstract
This is a Commentary on "Enhanced Enteral Feeding Versus Traditional Feeding in Neonatal Congenital Gastrointestinal Malformation Undergoing Intestinal Anastomosis: A Randomized Multicenter Controlled Trial of an Enhanced Recovery After Surgery (ERAS) Component" by Peng Y, Xiao D, Xiao S, et al.
Collapse
Affiliation(s)
- Mary Brindle
- Surgery and Community Health Sciences, University of Calgary, The EQuIS (Efficiency Quality Innovation and Safety), Alberta Children's Hospital, Director-Safe Surgery Safe Systems Program Ariadne Labs, Scientific Director-Province of Alberta Surgery Strategic Care Network, Calgary, Alberta, Canada.
| | - Kurt Heiss
- Emeritus of Surgery and Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, 6088 Millstone Run, Stone Mountain, GA 30087, USA.
| |
Collapse
|
11
|
Peng Y, Xiao D, Xiao S, Yang L, Shi H, He Q, Xu H, Zhu X, Zhong W, Yu J. Early enteral feeding versus traditional feeding in neonatal congenital gastrointestinal malformation undergoing intestinal anastomosis: A randomized multicenter controlled trial of an enhanced recovery after surgery (ERAS) component. J Pediatr Surg 2021; 56:1479-1484. [PMID: 33838898 DOI: 10.1016/j.jpedsurg.2021.02.067] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/04/2021] [Accepted: 02/17/2021] [Indexed: 01/19/2023]
Abstract
PURPOSE the aim of this clinical trial was to evaluate the safety and efficacy of early enteral feeding (EEN) following intestinal anastomosis in neonates with congenital gastrointestinal malformation. METHODS a multicenter, prospective, randomized controlled trial (registered under chictr.org.cn Identifier no.ChiCTR-INR-17014179) was conducted between 2018 and 2019. Four centers in China analyzed 156 newborns of congenital gastrointestinal malformation undergoing intestinal anastomosis to EEN group (n = 78) or control (C) group (n = 78). The primary outcomes of this study were length of postoperative stay (LOPS) and time to full feeds. Secondary outcomes included morbidity of complications, parenteral nutrition (PN) duration, feeding intolerance, 30 day mortality rate and 30 day readmission rate. RESULTS the mean time to full feeds and LOPS in the EEN group were 15.0 (9.8-22.8) days and 17.6 (12.0-29.8) days, while that were 18.0 (12.0-24.0) days and 20.0 (15.0-30.3) days in C groups respectively. There was no significant difference between two groups(P >0.05). No significant intergroup difference was found with respect to postoperative morbidity, PN duration or feeding intolerance(P >0.05). CONCLUSIONS early enteral feeding following intestinal anastomosis in neonates with congenital gastrointestinal malformation is safe. Post-operative outcomes demonstrated a trend toward improvement. LEVEL OF EVIDENCE Level Ⅰ.
Collapse
Affiliation(s)
- Yanfen Peng
- Department of Neonatal Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Dong Xiao
- Department of General Surgery, Shenzhen Children's Hospital, Shenzhen, China
| | - Shangjie Xiao
- Department of Neonatal Surgery, Guangdong Women and Children's Hospital, Guangdong, China
| | - Liucheng Yang
- Department of General Surgery, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Hui Shi
- Guangzhou Women and Children's Medical Center, Institute of Pediatrics, Guangzhou, China
| | - Qiuming He
- Department of Neonatal Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Haozhong Xu
- Department of General Surgery, Shenzhen Children's Hospital, Shenzhen, China
| | - Xiaochun Zhu
- Department of Neonatal Surgery, Guangdong Women and Children's Hospital, Guangdong, China
| | - Wei Zhong
- Department of Neonatal Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Jiakang Yu
- Department of Neonatal Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, China.
| |
Collapse
|
12
|
Tian Y, Zhu H, Gulack BC, Alganabi M, Ramjist J, Sparks E, Wong K, Shen C, Pierro A. Early enteral feeding after intestinal anastomosis in children: a systematic review and meta-analysis of randomized controlled trials. Pediatr Surg Int 2021; 37:403-410. [PMID: 33595685 DOI: 10.1007/s00383-020-04830-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Delayed enteral feeding (DEF) contributes to postoperative complications among children undergoing intestinal surgery. Various recent studies indicate the benefits of early enteral nutrition after intestinal surgery in adults. This systematic review and meta-analysis evaluates whether early enteral feeding (EEF) is beneficial in children who underwent intestinal anastomosis. METHODS MEDLINE, PubMed, the Cochrane Library, and Web of Science databases were searched for RCTs that addressed the effect of EEF in children (younger than 18 years old) undergoing intestinal anastomosis. EEF was defined as starting enteral feeding before the 3rd postoperative day. Studies were selected based on predetermined inclusion and exclusion criteria. A meta-analysis was performed using RevMan 5.3 to estimate odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals (CIs). RESULTS Four RCT studies met the inclusion criteria, comprising 97 cases with EEF and 89 cases with DEF. Enteral feeding started significantly earlier in the EEF group compared to the DEF group (MD = - 2.80; 95% CI - 3.11 to - 2.49; p < 0.00001). Postoperative anastomotic leak rate was unchanged between EEF and DEF groups (OR = 0.86; 95% CI 0.17-4.46; p = 0.86). The EEF group had a shorter length of hospital stay (MD = - 3.38; 95% CI - 4.29 to - 2.48; p < 0.00001), earlier time to bowel movement return (MD = - 0.57; 95% CI - 0.79 to - 0.35; p < 0.00001), lower incidence of surgical infection (OR = 0.27; 95% CI 0.08-0.90; p = 0.03), and faster tolerance of full enteral feeding (MD = - 2.00; 95% CI - 3.01 to - 2.79; p < 0.00001). Incidence of fever (OR = 0.37; 95% CI 0.10-1.31; p = 0.12), emesis, and abdominal distention (OR = 0.63; 95% CI 0.13-3.16; p = 0.58) were not different between the two groups. CONCLUSIONS Early enteral feeding after intestinal anastomosis in children does not increase the risk of postoperative anastomotic leak, fever, emesis, and abdominal distention. However, early enteral feeding is beneficial as it promotes the return of bowel function, reduces the length of hospital stay and the incidence of surgical infection in comparison to delayed enteral feeding.
Collapse
Affiliation(s)
- Yuxin Tian
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai, China
- National Children's Medical Center, Shanghai, China
| | - Haitao Zhu
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai, China
- National Children's Medical Center, Shanghai, China
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada
- Translational Medicine Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Brian C Gulack
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Mashriq Alganabi
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada
- Translational Medicine Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Joshua Ramjist
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - Eric Sparks
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - Kaitlyn Wong
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - Chun Shen
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai, China
- National Children's Medical Center, Shanghai, China
| | - Agostino Pierro
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada.
- Translational Medicine Program, The Hospital for Sick Children, Toronto, ON, Canada.
- Department of Surgery, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
13
|
Álvarez-Villaseñor AS, Prado-Rico SDC, Morales-Alvarado JI, Reyes-Aguirre LL, Fuentes-Orozco C, González-Ojeda A. Factors associated with dehiscence of intestinal anastomosis. CIR CIR 2021; 89:233-242. [PMID: 33784278 DOI: 10.24875/ciru.20000018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJETIVO Identificar los factores asociados a dehiscencia de anastomosis de intestino delgado y grueso. MÉTODO Se incluyeron 92 anastomosis de intestino delgado y grueso, en mayores de 18 años, realizadas en 2012-2016. Se evaluaron factores asociados en el preoperatorio, el transoperatorio y el posoperatorio. RESULTADOS Se presentó dehiscencia de anastomosis en el 13% de los casos. Se encontró una asociación significativa con ingesta previa de medicamentos (p = 0.05; odds ratio [OR]: 1.17; IC 95%) y con anastomosis primaria (p = 0.05; OR: 3.6; 0.92-14.5). En los pacientes con dehiscencia se incrementó la estancia intrahospitalaria. CONCLUSIÓN La presencia de dehiscencia de anastomosis fue similar a lo reportado en la literatura. Los factores asociados fueron la ingesta previa de medicamentos y la anastomosis primaria. OBJECTIVE To identify the factors associated with dehiscence of anastomosis of the small and large intestine. METHOD 92 anastomoses of the small and large intestine were included in patients over 18 years of age, performed in 2012-2016. Associated factors were evaluated in pre, trans and postoperative. RESULTS Anastomosis dehiscence was presented in 13%. A significant association was found for previous medication intake (p = 0.05; odds ratio [OR]: 1.17; 1.024-1.33) and primary anastomosis (p = 0.05, OR: 3.6; 0.92-14.5). In patients with dehiscence, the hospital stay was increased. CONCLUSION The presence of dehiscence of anastomosis was similar to that reported in the literature. The associated factors were previous medication intake, and primary anastomosis.
Collapse
Affiliation(s)
- Andrea S Álvarez-Villaseñor
- Departamento de Cirugía General, Benemérito Hospital General Juan María de Salvatierra, La Paz, Baja California Sur
| | | | - Jorge I Morales-Alvarado
- Departamento de Cirugía General, Benemérito Hospital General Juan María de Salvatierra, La Paz, Baja California Sur
| | - Laura L Reyes-Aguirre
- Unidad de Investigación Biomédica 02, Hospital de Especialidades, Unidad Médica de Alta Especialidad, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco. México
| | - Clotilde Fuentes-Orozco
- Unidad de Investigación Biomédica 02, Hospital de Especialidades, Unidad Médica de Alta Especialidad, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco. México
| | - Alejandro González-Ojeda
- Unidad de Investigación Biomédica 02, Hospital de Especialidades, Unidad Médica de Alta Especialidad, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco. México
| |
Collapse
|
14
|
Martín Parra JI, Toledo Martínez E, Martínez Pérez P, Ruiz Gómez JL, Fernández Santiago R, López Useros A, Manuel Palazuelos JC, Rodríguez Sanjuán JC. Analysis of learning styles in a laparoscopic technical skills course. Implications for surgical training. Cir Esp 2020; 99:S0009-739X(20)30380-8. [PMID: 33358409 DOI: 10.1016/j.ciresp.2020.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/28/2020] [Accepted: 11/15/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Learning surgical techniques is a dynamic process. In the 1980s David Kolb described developed a learning model that enabled teaching styles to adapt for better learner outcomes. The aim of this study was to identify the Kolb learning styles of the participants in a laparoscopic technical skills course and to check see if there was any relationship with performance. METHODS An observational descriptive study was conducted with 64 participants in an intensive course in which they performed laparoscopic manual intestinal anastomoses. All completed Kolb's inventory of learning styles. For each anastomosis, join quality was assessed and the performing time recorded. After that, they were analyzed through statistical studies. RESULTS The most frequent learning style was assimilating type (39.1%). No significant differences were observed between different learning styles and gender, professional category, the time taken or the quality of the anastomoses. CONCLUSIONS Assimilating type was the most frequent Kolb learning style, with no differences observed between categories, age or gender. There is no relationship between the learning style of the participants and the results obtained in the course.
Collapse
Affiliation(s)
- José Ignacio Martín Parra
- Servicio de Cirugía General, Hospital Universitario Marqués de Valdecilla, Santander, España; Hospital virtual Valdecilla, Santander, España.
| | - Enrique Toledo Martínez
- Servicio de Cirugía General, Hospital Universitario Marqués de Valdecilla, Santander, España; Hospital virtual Valdecilla, Santander, España
| | - Paula Martínez Pérez
- Servicio de Cirugía General, Hospital Universitario Marqués de Valdecilla, Santander, España; Hospital virtual Valdecilla, Santander, España
| | - José Luis Ruiz Gómez
- Hospital virtual Valdecilla, Santander, España; Hospital Comarcal Sierrallana, Torrelavega, Cantabria, España
| | - Roberto Fernández Santiago
- Servicio de Cirugía General, Hospital Universitario Marqués de Valdecilla, Santander, España; Hospital virtual Valdecilla, Santander, España
| | - Antonio López Useros
- Servicio de Cirugía General, Hospital Universitario Marqués de Valdecilla, Santander, España; Hospital virtual Valdecilla, Santander, España
| | - José Carlos Manuel Palazuelos
- Servicio de Cirugía General, Hospital Universitario Marqués de Valdecilla, Santander, España; Hospital virtual Valdecilla, Santander, España
| | - Juan Carlos Rodríguez Sanjuán
- Servicio de Cirugía General, Hospital Universitario Marqués de Valdecilla, Santander, España; Hospital virtual Valdecilla, Santander, España
| |
Collapse
|
15
|
Liu P, Mei Z, Shen G. A commentary on "Efficacy of single layered intestinal anastomosis over double layered intestinal anastomosis-an open labeled, randomized controlled trial". Int J Surg 2020; 80:153-154. [PMID: 32619619 DOI: 10.1016/j.ijsu.2020.06.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/18/2020] [Accepted: 06/22/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Peng Liu
- Department of Colorectal Surgery, Changhai Hospital, Second Military Medical University, 200433, Shanghai, China
| | - Zubing Mei
- Department of Anorectal Surgery, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, 201203, Shanghai, China; Anorectal Disease Institute of Shuguang Hospital, 201203, Shanghai, China.
| | - Guixin Shen
- Department of General Surgery, The Second Affiliated Hospital of Jiaxing University, 314000, Jiaxing, Zhejiang Province, China.
| |
Collapse
|
16
|
Aniruthan D, Pranavi AR, Sreenath GS, Kate V. Efficacy of single layered intestinal anastomosis over double layered intestinal anastomosis-an open labelled, randomized controlled trial. Int J Surg 2020; 78:173-8. [PMID: 32387214 DOI: 10.1016/j.ijsu.2020.04.066] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/17/2020] [Accepted: 04/28/2020] [Indexed: 11/23/2022]
Abstract
AIMS & OBJECTIVES The hand-sewn method of bowel anastomosis is the most common because of its affordability, familiarity and easy availability of materials. It can be done in single or double layers, with different surgeons preferring one technique over the other. Double layer intestinal anastomosis (DLIA) is time-consuming, challenging to perform, and carries possibly a higher risk of devascularisation, infection, and necrosis. Studies conducted so far do not show a significant difference between the two, but have concluded that more studies are required to determine this definitively. This study attempted to see whether the single layer intestinal anastomosis (SLIA) is non-inferior to DLIA in terms of incidence of anastomotic leak. It also compared mortality, morbidity, and length of hospitalization (LOH) between the two groups. MATERIALS AND METHODS This was a parallel arm, open labelled, non-inferiority randomized controlled trial conducted in the department of surgery in a tertiary care centre between October 2016 and March 2018. Patients who fulfilled the inclusion criteria were randomly allotted to two groups: Patients undergoing SLIA and patients undergoing DLIA. After the procedure, all patients were assessed for anastomotic leak, morbidity, mortality and LOH in the postoperative period. A 3-month follow-up period was observed for complications. RESULTS A total of 106 patients were randomised, 52 in SLIA and 54 in DLIA. Baseline demographic and clinicopathological characteristics between the two groups were comparable. The most common indication for intestinal anastomosis was ostomy closure in both groups. There was no significant difference between the two groups in terms of anastomotic leak, other complications, mortality and LOH. CONCLUSION SLIA was comparable to DLIA with respect to incidence of anastomotic leak, morbidity, mortality, and the length of hospitalization, and can be considered as a safe and feasible alternative, in elective and emergency settings.
Collapse
|
17
|
Zhao G, Ma J, Yan X, Li J, Ma F, Wang H, Liu Y, Lv Y. Optimized force range of magnetic compression anastomosis in dog intestinal tissue. J Pediatr Surg 2019; 54:2166-2171. [PMID: 30929946 DOI: 10.1016/j.jpedsurg.2019.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 02/20/2019] [Accepted: 03/11/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Magnetic compression anastomosis (MCA) is a commonly used anastomosis method. MCA was widely used in tissues repair, gastroenterostomy, choledochoenterostomy, and so on. It is safer and more effective than stapler and manual surgical suturing. However, there are few detailed studies on the biomechanical characteristics and tissue transformation mechanisms of the anastomosis process. In this research, taking intestinal tissue as research object, we need to determine an optimal compressive force range to provide a biomechanical reference for the design of anastomats. METHODS Magnets with different magnetic force groups (2.06, 3.21, 6.27, 13.3 and 19.2 N) were implanted into each dog to form intestinal tissue side-to-side anastomoses. Five dogs were euthanized on each of postoperative day 1, day 3, and day 7. Anastomoses were then harvested and compared with respect to postoperative complications, histology and tear-resistance load capacity (TRLC). RESULTS The TRLC of anastomotic tissue formed by magnets with different magnetic forces differed markedly, but with the tissue growth, the TRLC differences between groups were decreased. Histology of anastomotic tissue showed that, in the initial stage, the anastomoses compressed by 2.06-N magnets did not form effectively, while the leakage appeared in the anastomoses compressed by 19.2-N magnets, in the rest groups, with magnetic force increasing, severity of ischemia and necrosis of compressed tissue increased and healing speed of anastomotic tissue improved. In the late stage, the influence of magnetic force for anastomotic tissue was gradually diminished. CONCLUSIONS The magnetic force applied on the magnetic compression anastomats affects the necrosis speed of compressed tissue and the healing speed of anastomotic tissue. The optimal compressive force range for intestinal compression anastomosis is 6.27 N to 13.3 N, and the actual optimal compression pressure is 79.8 kPa - 169 kPa. LEVEL OF EVIDENCE Magnetic compression anastomosis (MCA) is a commonly used anastomosis method. MCA was widely used in tissues repair, gastroenterostomy, choledochoenterostomy, and so on. It is safer and more effective than stapler and manual surgical suturing. However, there are few detailed studies on the biomechanical characteristics and tissue transformation mechanisms of the anastomosis process. In this research, taking intestinal tissue as research object, we need to determine an optimal compressive force range to provide a biomechanical reference for the design of anastomats.
Collapse
Affiliation(s)
- Guangbin Zhao
- State Key Laboratory for Manufacturing Systems Engineering, Xi'an Jiaotong University, 710049, Xi'an, China.
| | - Jia Ma
- The First Affiliated Hospital of Xi'an Jiaotong University, 710061, Xi'an, China; National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an Jiaotong University, 710061, Xi'an, China; Department of surgical oncology, the Third Affiliated Hospital, Xi'an Jiaotong University, Shaanxi Provincial People's Hospital, 710068, Xi'an, China.
| | - Xiaopeng Yan
- The First Affiliated Hospital of Xi'an Jiaotong University, 710061, Xi'an, China; National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an Jiaotong University, 710061, Xi'an, China
| | - Jianhui Li
- The First Affiliated Hospital of Xi'an Jiaotong University, 710061, Xi'an, China; National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an Jiaotong University, 710061, Xi'an, China; Department of surgical oncology, the Third Affiliated Hospital, Xi'an Jiaotong University, Shaanxi Provincial People's Hospital, 710068, Xi'an, China
| | - Feng Ma
- The First Affiliated Hospital of Xi'an Jiaotong University, 710061, Xi'an, China; National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an Jiaotong University, 710061, Xi'an, China
| | - Haohua Wang
- The First Affiliated Hospital of Xi'an Jiaotong University, 710061, Xi'an, China; National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an Jiaotong University, 710061, Xi'an, China
| | - Yaxiong Liu
- State Key Laboratory for Manufacturing Systems Engineering, Xi'an Jiaotong University, 710049, Xi'an, China.
| | - Yi Lv
- The First Affiliated Hospital of Xi'an Jiaotong University, 710061, Xi'an, China; National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an Jiaotong University, 710061, Xi'an, China.
| |
Collapse
|
18
|
Chen M, Cao J, Huang D, Zhang B, Pan L, Zhang Z, Wang Z, Ye Y, Xiu D, Li D, Cai X. End-to-end intestinal anastomosis using a novel biodegradable stent for laparoscopic colonic surgery: a multicenter study. Surg Today 2019; 49:1003-1012. [PMID: 31256255 DOI: 10.1007/s00595-019-01841-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 06/02/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE Our animal studies have demonstrated the safety and feasibility of end-to-end intestinal anastomosis using a stent for laparoscopic colonic surgery. Therefore, we designed a non-inferiority trial to investigate the outcomes of stent anastomosis (SA) vs. those of conventional hand-sewn anastomosis (CA). METHODS A multicenter randomized controlled trial was conducted between December, 2016 and April, 2018. The primary outcome was the healing condition of the anastomoses, evaluated by endoscopy 6 months postoperatively. The secondary outcomes were the anastomotic completion time, anastomotic leak, intestinal obstruction, peritoneal effusion, and bleeding. Quality of life (QOL) was evaluated by questionnaires. RESULTS The subjects of this study were 60 patients, randomly divided into a SA group (n = 30) and a CA group (n = 30). There were no differences in anastomotic healing conditions (P = 1.00). The stent procedure was associated with a significantly shorter anastomosis time than the hand-sewn anastomosis (13.517 ± 4.281 vs. 20.333 ± 2.998 min, respectively; P < 0.001). There were no significant differences in anastomotic leakage, intestinal obstruction, peritoneal effusion, or bleeding between the groups. Questionnaires revealed almost no discrepancy between baseline QOL scores and those assessed 2, 4, 8, 12, and 24 weeks postoperatively in either group. CONCLUSIONS Intestinal anastomosis with a stent is a non-inferior strategy for laparoscopic colonic surgery, which requires less time for the anastomosis.
Collapse
Affiliation(s)
- Mingyu Chen
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, No.3 East Qingchun Road, Hangzhou, 310016, China
- Key Laboratory of Endoscopic Technique Research of Zhejiang Province, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou, 310016, China
| | - Jiasheng Cao
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, No.3 East Qingchun Road, Hangzhou, 310016, China
| | - Diyu Huang
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, No.3 East Qingchun Road, Hangzhou, 310016, China
| | - Bin Zhang
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, No.3 East Qingchun Road, Hangzhou, 310016, China
| | - Long Pan
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, No.3 East Qingchun Road, Hangzhou, 310016, China
| | - Zhongtao Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, 100032, China
| | - Zhenjun Wang
- Department of Anorectal Surgery, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Yingjiang Ye
- Department of Gastrointestinal Surgery, Peking University People's Hospital, Beijing, 100032, China
| | - Dianrong Xiu
- Department of General Surgery, Peking University Third Hospital, Beijing, 100089, China
| | - Dechuan Li
- Department of Colorectal Surgery, Zhejiang Cancer Hospital, Hangzhou, 310011, China
| | - Xiujun Cai
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, No.3 East Qingchun Road, Hangzhou, 310016, China.
- Key Laboratory of Endoscopic Technique Research of Zhejiang Province, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou, 310016, China.
| |
Collapse
|
19
|
Ma F, Ma J, Ma S, Fu S, Zhang Y, Liu H, Lv Y, Wu R, Yan X. A novel magnetic compression technique for small intestinal end-to-side anastomosis in rats. J Pediatr Surg 2019; 54:744-749. [PMID: 30064696 DOI: 10.1016/j.jpedsurg.2018.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 06/15/2018] [Accepted: 07/19/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Magnetic compression technology is a safe and convenient digestive tract reconstruction technique in large animals. The purpose of this study was to verify the feasibility of using the micromagnetic ring for construction of small intestinal end-to-side anastomosis in rats. METHODS Thirty male Sprague-Dawley albino rats were randomly divided into two groups: a study group that underwent small intestinal anastomosis with micromagnetic ring and a control group that had hand-sewn anastomosis. The time to construct the anastomosis, survival rate and incidence of complications were compared between the two groups. The anastomotic segments in each group were harvested on day 28 after surgery and investigated. RESULTS The mean anastomosis construction time was significantly lower in the study group than the control group (6.80 ± 1.97 min vs. 16.13 ± 3.29 min, P < 0.05). The survival rate was significantly higher in the study group (93.3%, 14/15) than the control group (66.7%, 10/15; P < 0.05). The incidence of anastomotic leakage [0% (0/15) vs. 6.67% (1/15), P = 1.000] and obstruction [20% (3/15) vs. 13.33% (2/15), P = 0.330] was similar in the study group and control group. The mean burst pressure did not differ significantly between the magnetic compression and hand-sewn anastomosis. In the study group, alignment of the tissue layers was improved and the inflammatory reaction was milder. CONCLUSION Use of a micromagnetic ring for small intestinal end-to-side anastomosis in rats is safe and feasible.
Collapse
Affiliation(s)
- Feng Ma
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an, China
| | - Jia Ma
- Department of Surgical Oncology, The Third Affiliated Hospital of Xi'an Jiaotong University (Shaanxi Provincial People's Hospital), Xi'an, China
| | - Sijie Ma
- Qide College, Xi'an Jiaotong University Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Shan Fu
- Qide College, Xi'an Jiaotong University Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Yanchao Zhang
- Qide College, Xi'an Jiaotong University Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Hao Liu
- Qide College, Xi'an Jiaotong University Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Yi Lv
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an, China
| | - Rongqian Wu
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an, China.
| | - Xiaopeng Yan
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an, China.
| |
Collapse
|
20
|
Liu X, Gao P, Du J, Zhao X, Wong KKY. Long-term anti-inflammatory efficacy in intestinal anastomosis in mice using silver nanoparticle-coated suture. J Pediatr Surg 2017; 52:2083-2087. [PMID: 28958713 DOI: 10.1016/j.jpedsurg.2017.08.026] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 08/28/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND In our previous study, we coated silver nanoparticles (AgNPs) onto the surface of absorbable braided suture using layer-by-layer deposition and demonstrated significant anti-inflammatory property during the early phase of intestinal anastomosis healing in mice. The present study aimed to further investigate the long-term anti-inflammatory efficacy. METHODS AgNP-coated suture, antibiotic coated suture, and normal suture were respectively used for single layered, interrupted intestinal anastomosis. The anastomotic segments in each group were harvested on day 14, day 21, and day 28 postoperation and investigated for the degree of inflammation by cell infiltration and expression of cytokines as well as collagen deposition. RESULTS When compared with the control groups, the AgNP-coated suture group showed better histological appearance in the intestinal anastomotic segments at each time point. Immunohistochemistry staining and quantitative evaluation further indicated less macrophage infiltration and decreased production of IL-6, IL-10, and TNF-α (p<0.05). Masson staining showed normal collagen deposition and remodeling at intestinal anastomotic tissue in the AgNP-coated suture group. CONCLUSION Our study shows that AgNP-coated suture provides better long-term anti-inflammatory efficacy and ideal tissue remodeling in intestinal anastomosis. Despite these findings, clinical trials are still needed for evaluation before medical application.
Collapse
Affiliation(s)
- Xuelai Liu
- Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Peng Gao
- Department of Surgery, Harbin Children's Hospital, Harbin, China
| | - Juan Du
- Department of Medicine, Changchun Central Hospital, Changchun, Jilin Province, China
| | - Xin Zhao
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Kenneth K Y Wong
- Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
| |
Collapse
|
21
|
Danielski LG, Walczewski E, de Jesus CR, Florentino D, Giustina AD, Goldim MP, Kanis LA, Pereira GW, Pereira VD, Felisberto F, Petronilho F. Preoperative vitamin C supplementation improves colorectal anastomotic healing and biochemical parameters in malnourished rats. Int J Colorectal Dis 2016; 31:1759-66. [PMID: 27614446 DOI: 10.1007/s00384-016-2647-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/30/2016] [Indexed: 02/06/2023]
Abstract
PURPOSES The objective of this study was to evaluate the effect of supplementation with vitamin C on intestinal anastomosis healing in malnourished rats. METHODS Male Wistar rats were divided into three groups: (1) sham, well-nourished rats that received vehicle; (2) FR+Veh, rats that were subjected to food restriction and received vehicle; and (3) FR+VC, rats that were subjected to food restriction and received vitamin C. Four days before surgery, the animals received vitamin C (100 mg/kg/day) via gavage and underwent colon resection with anastomosis in a single plane. The survival rate of rats was monitored until day 7 after surgery. Regarding anastomosis tissues, we examined intra-abdominal adhesion index, hydroxyproline content, collagen density, inflammatory parameters, and oxidative damage to proteins and lipids. RESULTS Malnutrition decreases body weight and increases mortality; the survival rate was 90 % in group 1, 60 % in group 2, and 80 % in group 3. Vitamin C was able to increase hydroxyproline concentration and density of collagen and decrease the intra-abdominal adhesion index, as well as the infiltration of neutrophils and oxidative damage to proteins in malnourished rats compared to group treated with vehicle. CONCLUSIONS Preoperative vitamin C supplementation can improve the intestinal anastomosis healing, biochemical alterations, and prolong survival in rats subjected to food restriction.
Collapse
|
22
|
Gehrig T, Billeter AT, Wekerle AL, Shevchenko M, Brand K, Müller-Stich BP. Evaluation of the LigaSure(™) Vessel Sealing System for bowel transection and intestinal anastomosis-an experimental study in a porcine model. Langenbecks Arch Surg 2016; 401:381-7. [PMID: 27007724 DOI: 10.1007/s00423-016-1406-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 03/11/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND The purpose of the present study is to assess the value of the LigaSure™ Vessel Sealing System (LVSS) as a means for bowel transection and intestinal anastomosis. METHODS We compared the LVSS for (1) transecting bowel and (2) creation of an intestinal anastomosis with standard methods such as stapler (S) and hand-sewn (HS) in a porcine model. For each study arm, i.e., bowel transection and anastomosis creation, both the small bowel and colon were examined. In total, ten transections and ten anastomoses were performed for each. Burst and anastomotic leak pressures were compared. RESULTS In the study arm 1, LVSS achieved lowest burst pressures in both small bowel (LVSS 39.8 ± 3.6 mmHg, S 81.9 ± 3.9, HS 111.9 ± 14.7 mmHg, p < 0.0001) and colon transections (LVSS 21.5 ± 2.6 mmHg, S 79.5 ± 4.9, HS 91.0 ± 5.2 mmHg, p < 0.0001). There was no difference in burst pressures between S and HS in both small bowel and colon transections. In the study arm 2, LVSS showed the lowest anastomotic leak pressures for small bowel (LVSS 26.4 ± 2.6 mmHg, S 52.1 ± 6.2, HS 87.4 ± 7.0 mmHg, p < 0.0001) and colonic anastomoses (LVSS 16.9 ± 1.3 mmHg, S 55.9 ± 4.3, HS 74.4 ± 4.4 mmHg, p < 0.0001). Furthermore, small bowel and colonic anastomoses using S demonstrated significantly lower leak pressures than HS anastomosis p < 0.001 and p = 0.004, respectively. CONCLUSIONS The LVSS achieves significantly lower burst pressures and anastomotic leak pressures for bowel transection and intestinal anastomosis than S and HS techniques. However, due to the achieved pressure levels of 39.8 ± 3.6 mmHg, LVSS appears to be a sufficient stand-alone method for bowel transection. Whether it can be used to perform intestinal anastomosis warrants further research in a survival model.
Collapse
|
23
|
Ryou M, Aihara H, Thompson CC. Minimally invasive entero-enteral dual-path bypass using self-assembling magnets. Surg Endosc. 2016;30:4533-4538. [PMID: 26895911 DOI: 10.1007/s00464-016-4789-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 01/22/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND A minimally invasive method of entero-enteral bypass may be desirable for treatment of obstruction, obesity, or metabolic syndrome. We have developed a technology based on miniature self-assembling magnets which create large-caliber anastomoses (incisionless anastomosis system or IAS). The aim of this study was to assess (a) procedural characteristics of IAS deployment and (b) long-term integrity and patency of the resulting jejuno-ileal dual-path bypass. METHODS Endoscopic jejuno-ileal bypass creation using IAS magnets was performed in 8 Yorkshire pigs survived 3 months. PROCEDURE The jejunal magnet was endoscopically deployed. However, the ileal magnet required surgical delivery given restraints of porcine anatomy. A 5-mm enterotomy was created through which the ileal magnet was inserted using a modified laparoscopic delivery tool. Magnets were manually coupled. Pigs underwent serial endoscopies for anastomosis assessment. Three-month necropsies were performed, followed by pressure testing of anastomoses and histological analysis. RESULTS Jejuno-ileal bypass creation using self-assembling IAS magnets was successful in all 8 pigs (100 %). Patent, leak-free bypasses formed in all animals by day 10. All IAS magnets were expelled by day 12. Anastomoses were widely patent at 3 months, with mean maximal diameter of 30 mm. At necropsy, adhesions were minimal. Pressure testing confirmed superior integrity of anastomotic tissue. Histology showed full epithelialization across the anastomosis with no evidence of submucosal fibrosis or inflammation. CONCLUSIONS Entero-enteral bypass using self-assembling IAS magnets is safe and technically feasible in the porcine model. IAS magnets can be rapidly delivered endoscopically or through a modified laparoscopic device. Expulsion of fused magnets avoids retention of prosthetic material. Anastomoses are widely patent and fully re-epithelialized. Three-month pressure testing reveals anastomotic tissue to be as robust as native tissue, while necropsy and histology suggests minimal/absent tissue inflammation. In human anatomy, a fully endoscopic jejuno-ileal bypass using IAS magnets may be feasible.
Collapse
|
24
|
Torres-Melero J, Motos-Micó JJ, Lorenzo-Liñán M, Morales-González Á, Rosado-Cobián R. [Use of absorbable fibrin sealant patch to strengthen the gastro intestinal anastomosis performed on patients with peritoneal carcinomatosis treated with intention to cure by debulking surgery and intraoperative hyperthermic intraperitoneal chemotherapy]. CIR CIR 2016; 84:102-8. [PMID: 26776435 DOI: 10.1016/j.circir.2015.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 09/14/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Peritoneal disseminated disease, regardless of its origin, should currently be considered a locoregional disease stage, and thus a candidate for an intention to treat therapeutic option with debulking surgery and hyperthermic intraperitoneal chemotherapy. OBJECTIVE To determine whether or not the collagen sponge with fibrinogen 5.5mg and thrombin 2IU, applied as a tissue sealant and gastrointestinal reinforcement sutures, contributes to the reduction of anastomotic leak. MATERIAL AND METHODS Quasi-experimental, comparative, prospective, case/control study conducted on patients with peritoneal carcinomatosis of colorectal origin, operated on in our Peritoneal Cancer Surgery Unit from 2011 to April 2014. The study included 73 patients, 43 (59%) men and 30 (41%) women with peritoneal carcinomatosis of colorectal origin, candidates for debulking surgery and hyperthermic intraperitoneal chemotherapy. Gastrointestinal anastomoses were performed on 49 (67%) patients. These patients were randomised into 2 groups: A control (27) and B hypothesis (22) reinforced with sponge suture. RESULTS The total number of anastomoses performed was 49 (mean: 1.9), with 27 in the control group A (mean: 1.88) and 22 in B (mean: 2.16). The debulkings achieved were: complete debulking 0.38 (77.5%), complete debulking 1: 7 (14.8%), and 4 (8.1%) did not undergo hyperthermic intraperitoneal chemotherapy due to complete debulking>2. Intestinal fistula: 3 cases (6.1%) in A group vs 0 in B. CONCLUSIONS In our series, the use of a fibrinogen and thrombin sponge has contributed to a significant reduction in the risk of gastrointestinal fistulas in high risk oncology patients.
Collapse
|
25
|
Schoeb DS, Klink CD, Lambertz A, Eickhoff R, Busch D, Ulmer TF, Neumann UP, Binnebösel M. Influence of gentamicin-coded PVDF suture material on the healing of intestinal anastomosis in a rat model. Int J Colorectal Dis 2015; 30:1571-80. [PMID: 26260480 DOI: 10.1007/s00384-015-2345-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/27/2015] [Indexed: 02/04/2023]
Abstract
PURPOSE Intestinal anastomosis is a fundamental procedure in general surgery and required to restore intestinal continuity following resection. The aim of this study was to evaluate whether a gentamicin-coated polyvinylidene fluoride (PVDF) suture material has beneficial effect on anastomotic healing. METHODS Ninety Sprague-Dawley rats were divided into three groups: a PVDF-suture group, a gentamicin-coated PVDF (GPVDF)-suture group and a control group using Maxon® (polyglycolid-co-trimethylene carbonate). For each animal, a colonic anastomosis was performed. Ten animals from each group were sacrificed on postoperative days 3, 5, and 14. Measurements of anastomotic bursting pressure were performed on days 3 and 5. At each time, collagen type I/III ratio, MMP 2 and MMP-9 expression and the proliferation index (Ki67) were analyzed. RESULTS In total, 90 animals underwent surgery without postoperative complications. Bursting strength in the GPVDF group was significantly elevated on day 5. Immunohistochemistry showed significant increase of the collagen type I/III ratio for PVDF and GPVDF on days 3 and 5. MMP2 was significantly increased for PVDF on days 3 and 5 and for GPVDF on day 5. The analysis of MMP9 revealed significant increase compared to control on day 3 and 5 (GPVDF) as well as on day 5 (PVDF). Staining for Ki67 revealed a significant elevation on postoperative day 3 for the PVDF and the GPVDF group. CONCLUSIONS The present data shows the feasibility of PVDF as suture material for colonic anastomosis and confirms the ability of gentamicin to increase the stability of colonic anastomosis when used as coating material.
Collapse
|
26
|
Fonseca Martín R, Couselo Jerez M, Bordallo Vázquez M, Vila Carbó JJ. [Isolated intestinal perforation in neonates: treatment with ostomy or primary anastomosis?]. Cir Pediatr 2015; 28:10-14. [PMID: 27775265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Necrotizing enterocolitis and isolated intestinal perforation (IIP) are two different entities that have been often analysed together in the literature. We present our series of IIP cases who received surgical treatment by laparotomy. MATERIAL AND METHODS A retrospective cohort study was conducted with neonates diagnosed of IPP and operated on between 2002 and 2013. We divided the sample into two groups: group O (laparotomy and ostomy) and Group S (laparotomy and primary repair of the perforation). We compared the following variables: mortality, development of complications and number of days of total parenteral nutrition (TPN). Categorical variables were compared with the χ2 test. Time of TPN was analysed with Kaplan Meier curves and comparison between groups with the log-rank test. RESULTS Thirty-four patients underwent surgery. Fourteen patients were included in group O and 20 in group S. Four (28,6%) cases died in group O and six (30.0%) in group S: no statistically significant differences were found in mortality (χ2= 0.08; p= 0.9). Four (28,6%) patients in group O presented complications compared with 7 (35%) in group S: there were no statistically significant differences (χ2= 0.1; p= 0.7). The median number of days of TPN was 38 in group O and 34 in group S: no significant differences were found (χ2= 1.4; p = 0.2). CONCLUSIONS No significant differences were found in terms of mortality, surgical complications and TPN between patients with IIP treated with primary anastomosis and patients treated with an ostomy.
Collapse
Affiliation(s)
- R Fonseca Martín
- Servicio de Cirugía Pediátrica. Hospital Universitario y Politécnico La Fe. Valencia
| | - M Couselo Jerez
- Servicio de Cirugía Pediátrica. Hospital Universitario y Politécnico La Fe. Valencia
| | - M Bordallo Vázquez
- Servicio de Cirugía Pediátrica. Hospital Universitario y Politécnico La Fe. Valencia
| | - J J Vila Carbó
- Servicio de Cirugía Pediátrica. Hospital Universitario y Politécnico La Fe. Valencia
| |
Collapse
|
27
|
Jensen JS, Petersen NB, Biagini M, Bollen P, Qvist N. Infliximab treatment reduces tensile strength in intestinal anastomosis. J Surg Res 2014; 193:145-52. [PMID: 25156230 DOI: 10.1016/j.jss.2014.07.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 05/11/2014] [Accepted: 07/10/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND The antitumor necrosis factor (infliximab [IFX]) has gained widespread use in the treatment of inflammatory bowel disease. However, several patients must undergo surgical treatment due to treatment failure and there is a potential risk that preoperative IFX treatment may have a negative effect on the healing process in intestinal anastomosis. The objective of this study was to examine the effect of repeated IFX treatment on anastomotic strength and degree of inflammation in the anastomotic line in the small intestine of rabbits. METHODS Thirty-two rabbits were randomized (2:1) to receive either repeated IFX treatment or placebo. On day 15, three separate end-to-end anastomoses were performed on the jejunum. On postoperative day 5, tensile strength and bursting pressure for the anastomoses were tested and histologic changes examined. RESULTS We found a significantly reduced tensile strength in the IFX group (1.94 ± 0.44 N) compared with the placebo group (3.33 ± 0.39 N), (P < 0.001). Calculation of Spearman correlation coefficients showed a positive significant correlation between minimal tensile strength and serum values of IFX (coefficient = -0.63; P = 0.003) as well as number of sutures in the tested anastomosis (coefficient = 0.51; P = 0.024). The general histologic score was significantly higher in the placebo group (5.00 ± 1.26 versus 3.31 ± 1.65, P = 0.03). CONCLUSIONS Repeated high-dose IFX treatment reduces tensile strength significantly in rabbits and should be investigated further as a potential risk factor of anastomotic dehiscence in inflammatory bowel disease surgery.
Collapse
Affiliation(s)
| | | | - Matteo Biagini
- Department of Pathology, Odense University Hospital, Odense, Denmark
| | - Peter Bollen
- Biomedical Laboratory, Faculty of Health Science, University of Southern Denmark, Odense Denmark
| | - Niels Qvist
- Department of Surgery A, Odense University Hospital, Odense, Denmark.
| |
Collapse
|
28
|
Morse BC, Simpson JP, Jones YR, Johnson BL, Knott BM, Kotrady JA. Determination of independent predictive factors for anastomotic leak: analysis of 682 intestinal anastomoses. Am J Surg 2013; 206:950-5; discussion 955-6. [PMID: 24070663 DOI: 10.1016/j.amjsurg.2013.07.017] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 07/18/2013] [Accepted: 07/25/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND The objective of this study was to identify risk factors associated with intestinal anastomotic leakage in order to practically assist in surgical decision making. METHODS A retrospective review of an academic surgery database was performed over 5 years to identify patients who had intestinal (small bowel and colon) anastomoses to determine independent predictors of anastomotic leakage. RESULTS Over the study period, 682 patients were identified with intestinal anastomoses; the overall leak rate was 5.6% (38/682). In bivariate analysis, 9 factors were associated with anastomotic leaks. Of these, 3 were found to be independent predictors of anastomotic leakage using a logistic regression model: anastomotic tension (odds ratio [OR] = 10.1, 95% Confidence Interval [CI] 1.3 to 76.9), use of drains (OR = 8.9, 95% CI 4.3 to 18.4), and perioperative blood transfusion (OR = 4.2, 95% CI 1.4 to 12.3). CONCLUSIONS The recognition of factors associated with anastomotic leakage after intestinal operations can assist surgeons in mitigating these risks in the perioperative period and guide intraoperative decisions.
Collapse
Affiliation(s)
- Bryan C Morse
- Academic Department of Surgery, Division of General Surgery, Greenville Memorial Hospital, University of South Carolina School of Medicine-Greenville, 3rd Floor, 701 Grove Road, Greenville, SC 29605, USA.
| | | | | | | | | | | |
Collapse
|
29
|
Abstract
A prospective nonrandomized study of 31 children aged <16 years over a period of 14 months was conducted to evaluate the effects of early oral feeding (EOF) in children with intestinal anastomosis. Patients undergoing elective or emergency intestinal anastomosis below the ligament of Trietz with no contamination were included while contaminated cases and neonatal atresias were excluded. First feed was the direct oral feed started within 24 h, usually the morning after surgery. Liquid feeds were started initially and increased at 4 hourly increments to appropriate feed for age. Time to full feeds was recorded. Patients were monitored for vomiting, abdominal distension, and signs of leak. Time to first stool and length of hospital stay were recorded. Median age of patient was 12 months. Mean time to first feed was 16 h, and mean time to full feeds was 36 h. Four of the 31 patients had delayed tolerance to feed, either due to vomiting or distension, which was transient and resolved spontaneously in three patients and due to prolonged ileus in the fourth patient. None of the patients had leaks. Most of the patients were discharged by postoperative day 3 (83 %). Early enteral feeding in pediatric intestinal anastomosis can be safely started without looking for traditional markers of return of bowel activity. It lowers hospital stay with no adverse effects. Generalization of this concept to selected emergency and neonatal surgeries can be considered, but needs further randomized control trial to validate.
Collapse
Affiliation(s)
- Mamatha B
- Department of Paediatric Surgery, Bangalore Medical College and Research Institute, Fort, Bangalore, 560002 India
| | - Anand Alladi
- Department of Paediatric Surgery, Bangalore Medical College and Research Institute, Fort, Bangalore, 560002 India
| |
Collapse
|
30
|
Czeiger D, Osyntsov A, Osyntsov L, Ball CG, Gigi R, Shaked G. Examining the safety of colon anastomosis on a rat model of ischemia-reperfusion injury. World J Emerg Surg 2013; 8:24. [PMID: 23819877 PMCID: PMC3703257 DOI: 10.1186/1749-7922-8-24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 06/27/2013] [Indexed: 12/16/2022] Open
Abstract
Introduction Intestinal ischemia and reperfusion can impair anastomotic strength. The purpose of this study was to evaluate the safety of delayed colon anastomosis following remote ischemia-reperfusion (IR) injury. Methods Rats divided into two groups underwent bilateral groin incisions, however only the study group had femoral artery clamping to inflict IR injury. Twenty-four hours following this insult, the animals underwent laparotomy, incision of the transverse colon and reanastomosis. End points included anastomotic leakage, strength and histopathological features. Results Anastomotic leak among IR animals (22.2%) was not statistically different in comparison to the controls [10.5% (p = 0.40)]. Anastomotic mean burst pressures showed no statistically significant difference [150.6 ± 15.57 mmHg in the control group vs. 159.9 ± 9.88 mmHg in the IR group (p = 0.64)]. The acute inflammatory process in the IR group was similar to controls (p = 0.26), as was the chronic repair process (p = 0.88). There was no significant difference between the inflammation:repair ratios amongst the two groups (p = 0.67). Conclusion Primary colon repair is safe when performed 24 hours following systemic IR injury.
Collapse
Affiliation(s)
- David Czeiger
- Department of General Surgery and Trauma Unit, Soroka University Medical Center and Ben-Gurion University, Beer Sheva, Israel
| | - Anton Osyntsov
- Department of General Surgery, Soroka University Medical Center and Ben-Gurion University, Beer Sheva 84101, Israel
| | - Lidia Osyntsov
- Pathology Institute, Soroka University Medical Center and Ben- Gurion University, Beer Sheva, Israel
| | - Chad G Ball
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Roy Gigi
- Department of Orthopedics, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Gad Shaked
- Department of General Surgery and Trauma Unit, Soroka University Medical Center and Ben-Gurion University, Beer Sheva, Israel ; Department of General Surgery, Soroka University Medical Center and Ben-Gurion University, Beer Sheva 84101, Israel
| |
Collapse
|
31
|
Bangaru H, Veitla RMR, Pigilam M, Kunwargiri GK. Comparative Study between Staplers and Conventional(Hand-Sewn) Anastomosis in Gastrointestinal Surgery. Indian J Surg 2012; 74:462-7. [PMID: 24293900 DOI: 10.1007/s12262-012-0450-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2011] [Accepted: 03/05/2012] [Indexed: 11/30/2022] Open
Abstract
Conventional (hand-sewn) technique of intestinal anastomosis has been in vogue for decades. Staplers which were developed to simplify surgery began to have significant impact. To compare staplers versus conventional anastomosis with respect to certain intra operative and post operative parameters. Prospective study from November 2008 to October 2010 in Hyderabad at OSMANIA, GANDHI, MNJ CANCER hospitals. 120 patients were divided into three groups of 40 each, depending on the surgery like posterior gastrojejunostomy, distal gastrectomy and reconstruction (Billroth II) and colorectal anastomosis. Of these 40 patients, 20 were in hand-sewn group and the other 20 in stapler group. Unpaired 't' test was used to find 'p' value . 'p' value less than 0.05 was considered statistically significant. Total operating time was shortened in stapler group. No significant difference was found in terms of restoration of intestinal function, post-operative hospital stay, post-operative complications like anastomotic leak. Staplers can expedite surgery. They have better access to difficult-to-reach areas. Thus staplers can be beneficial though one should not forget the art of conventional suturing.
Collapse
Affiliation(s)
- Himabindu Bangaru
- General Surgery, Osmania General Hospital, D/O B. Balachandra H.NO:3-12-117/140 P.S. Colony, OPP.T.V Studio, Ramantapur, Hyderabad, 500013 AP India
| | | | | | | |
Collapse
|