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Ford C, Hill B. A guide to removing surgical staples. Br J Nurs 2024; 33:372-380. [PMID: 38639750 DOI: 10.12968/bjon.2024.33.8.372] [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] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
This article provides a comprehensive overview of the wound healing process, emphasising the critical role of surgical staples in primary intention healing. It outlines the four distinct phases of wound healing including haemostasis, inflammation, proliferation, and maturation - and discusses the mechanisms by which surgical staples enhance this natural biological process. Special focus is given to the aseptic non-touch technique (ANTT), which is crucial in preventing infections during the staple removal procedure. The article further explores the procedural steps involved in the removal of surgical staples and highlights the holistic aspects of patient care that need to be considered. This includes strategies for effective pain management, ensuring informed consent, and maintaining a sterile environment. By integrating clinical skills with a thorough understanding of wound care, this article aims to improve nursing practices in surgical settings, promoting better patient outcomes and recovery.
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Affiliation(s)
- Claire Ford
- Assistant Professor, Adult Nursing, Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne
| | - Barry Hill
- Associate Professor of Nursing and Critical Care, Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne
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Aguirre-Allende I, Alkorta-Zuloaga M, Iglesias-Gaspar MT, Urreta-Ballobre I, García-Domínguez A, Arteaga-Martin X, Beguiristain-Gómez A, Medrano-Gómez MÁ, Ruiz-Montesinos I, Riverola-Aso AP, Jiménez-Agüero R, Enríquez-Navascués JM. Subcuticular suture and incisional surgical-site infection in elective hepatobiliary and pancreatic surgery: an open-label, pragmatic randomized clinical trial (CLOSKIN trial). BMC Surg 2023; 23:9. [PMID: 36639756 PMCID: PMC9837932 DOI: 10.1186/s12893-023-01911-0] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Subcuticular suture has proven to reduce superficial incisional SSI (si-SSI) in clean surgery. However, question remains regarding clean-contaminated procedures. The aim of this study is to assess if subcuticular suture is superior to staples in reducing si-SSI incidence in elective HBP surgery. METHODS Single-centre, open-label, parallel, pragmatic randomized clinical trial conducted at a referral tertiary Hospital between January 2020 and April 2022. Patients eligible for elective HBP surgery were randomly assigned (1:1) to subcuticular suture or surgical staples wound closure using a minimisation method based on previously confirmed risk factors. The primary endpoint was the incidence of si-SSI. Considered secondary endpoints were major postoperative morbidity in both groups, additional wound complications, median hospital length of stay and need for re-hospitalisation. RESULTS Of the 379 patients, 346 patients were randomly assigned to receive skin closure with staples (n = 173) or subcuticular suture (n = 173). After further exclusion of 11 participants, 167 and 168 patients, respectively in the control and the experimental group received their allocated intervention. For the primary endpoint, no significant differences in si-SSI rate were found: 17 (9.82%) staples group vs. 8 (4.62%) in subcuticular suture group (p = 0.062). Subset analysis confirmed absence of significant differences. As for secondary endpoints, overall wound complications did not differ significantly between two procedures: 19 (10.98%) vs. 10 (6.35%) (p = 0.127). There were no treatment related adverse events. However, occurrence of si-SSI contributed to major postoperative morbidity in both groups (p < 0.001 and p = 0.018) and to a substantially prolonged postoperative hospitalization (p = 0.015). CONCLUSIONS Subcuticular suture might offer a relative benefit for skin closure reducing incidence of si-SSI after elective HBP surgery, although this was found not to be clinically relevant. Yet, this should not be interpreted as equivalence among both treatments. Therefore, wound closure strategy should not be based only on these grounds. TRIAL REGISTRATION NUMBER ISRCTN Registry number ISRCTN37315612 (registration date: 14/01/2020).
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Affiliation(s)
- Ignacio Aguirre-Allende
- grid.414651.30000 0000 9920 5292General and Digestive Surgery Department, Hepatobiliary and Pancreatic Surgery Unit, Donostia University Hospital-IHO Donostialdea, IIS Biodonostia, Paseo Doctor Beguiristain S/N, 20014 Donostia-San Sebastian, Spain
| | - Maialen Alkorta-Zuloaga
- grid.414651.30000 0000 9920 5292General and Digestive Surgery Department, Hepatobiliary and Pancreatic Surgery Unit, Donostia University Hospital-IHO Donostialdea, IIS Biodonostia, Paseo Doctor Beguiristain S/N, 20014 Donostia-San Sebastian, Spain
| | - Maria Teresa Iglesias-Gaspar
- grid.414651.30000 0000 9920 5292Clinical Epidemiology Unit, Donostia University Hospital-IHO Donostialdea, IIS Biodonostia, Paseo Doctor Beguiristain S/N, 20014 Donostia-San Sebastian, Spain
| | - Iratxe Urreta-Ballobre
- grid.414651.30000 0000 9920 5292Clinical Epidemiology Unit, Donostia University Hospital-IHO Donostialdea, IIS Biodonostia, Paseo Doctor Beguiristain S/N, 20014 Donostia-San Sebastian, Spain
| | - Amaia García-Domínguez
- grid.414651.30000 0000 9920 5292General and Digestive Surgery Department, Donostia University Hospital-IHO Donostialdea, IIS Biodonostia, Paseo Doctor Beguiristain S/N, 20014 Donostia-San Sebastian, Spain
| | - Xabier Arteaga-Martin
- grid.414651.30000 0000 9920 5292General and Digestive Surgery Department, Hepatobiliary and Pancreatic Surgery Unit, Donostia University Hospital-IHO Donostialdea, IIS Biodonostia, Paseo Doctor Beguiristain S/N, 20014 Donostia-San Sebastian, Spain
| | - Adolfo Beguiristain-Gómez
- grid.414651.30000 0000 9920 5292General and Digestive Surgery Department, Hepatobiliary and Pancreatic Surgery Unit, Donostia University Hospital-IHO Donostialdea, IIS Biodonostia, Paseo Doctor Beguiristain S/N, 20014 Donostia-San Sebastian, Spain
| | - Miguel Ángel Medrano-Gómez
- grid.414651.30000 0000 9920 5292General and Digestive Surgery Department, Hepatobiliary and Pancreatic Surgery Unit, Donostia University Hospital-IHO Donostialdea, IIS Biodonostia, Paseo Doctor Beguiristain S/N, 20014 Donostia-San Sebastian, Spain
| | - Inmaculada Ruiz-Montesinos
- grid.414651.30000 0000 9920 5292General and Digestive Surgery Department, Hepatobiliary and Pancreatic Surgery Unit, Donostia University Hospital-IHO Donostialdea, IIS Biodonostia, Paseo Doctor Beguiristain S/N, 20014 Donostia-San Sebastian, Spain
| | - Ana Paula Riverola-Aso
- grid.414651.30000 0000 9920 5292General and Digestive Surgery Department, Hepatobiliary and Pancreatic Surgery Unit, Donostia University Hospital-IHO Donostialdea, IIS Biodonostia, Paseo Doctor Beguiristain S/N, 20014 Donostia-San Sebastian, Spain
| | - Raúl Jiménez-Agüero
- grid.414651.30000 0000 9920 5292General and Digestive Surgery Department, Hepatobiliary and Pancreatic Surgery Unit, Donostia University Hospital-IHO Donostialdea, IIS Biodonostia, Paseo Doctor Beguiristain S/N, 20014 Donostia-San Sebastian, Spain
| | - José María Enríquez-Navascués
- grid.414651.30000 0000 9920 5292General and Digestive Surgery Department, Colorectal Surgery Unit, Donostia University Hospital-IHO Donostialdea, IIS Biodonostia, Paseo Doctor Beguiristain S/N, 20014 Donostia-San Sebastian, Spain
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Aitchison LP, Chen AZL, Toms C, Sandroussi C, Yeo DA, Steffens D. To stitch or not to stitch: the skin closure of laparoscopic port sites, a meta-analysis. Surg Endosc 2022; 36:7140-7159. [PMID: 35610480 PMCID: PMC9485090 DOI: 10.1007/s00464-022-09269-9] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 04/09/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Previous meta-analyses examining skin closure methods for all surgical wounds have found suture to have significantly decreased rates of wound dehiscence compared to tissue adhesive; however, this was not specific to laparoscopic wounds alone. This study aims to determine the best method of skin closure in patients undergoing laparoscopic abdominopelvic surgery in order to minimize wound complications and pain, while maximize cosmesis, time and cost efficiency. METHODS A comprehensive search of EMBASE, Medline, Pubmed, and CENTRAL was conducted from inception to 1st May 2020 for randomized controlled trials (RCTs). Two independent reviewers extracted data and assessed risk of bias. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to describe the quality of evidence. Meta-analysis was performed using a random-effects model. A summary relative risk (RR) was calculated for dichotomous outcomes where data could be pooled. (Prospero registration number: CRD42019122639). RESULTS The literature search identified 11,628 potentially eligible studies. Twelve RCTs met inclusion criteria. There was no difference in wound complications (infection, dehiscence, and drainage) between sutures, tissue adhesives nor adhesive papertape. Low-quality evidence found transcutaneous suture had lower rates of wound complications compared with subcuticular sutures (RR 0.22, 95%: CI 0.05-0.98). There was no evidence of a difference in patient-evaluated cosmesis, prolonged pain, or patient satisfaction between the three groups. Closure with tissue adhesive and adhesive papertape was faster and cheaper than suture. CONCLUSION Tissue adhesive and adhesive papertape offer safe, cost and time-saving alternatives to closure of laparoscopic port sites compared to suture.
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Affiliation(s)
- Lucy P. Aitchison
- Surgical Outcomes Research Centre (SOuRCe), The University of Sydney and Sydney Local Health District, Sydney, NSW Australia
- Faculty of Medicine, Prince of Wales Clinical School, The University of New South Wales, Sydney, NSW Australia
- Department of Surgery, Royal North Shore Hospital, St Leonards, Sydney, NSW 2062 Australia
| | - Andy Z. L. Chen
- Surgical Outcomes Research Centre (SOuRCe), The University of Sydney and Sydney Local Health District, Sydney, NSW Australia
- Department of Surgery, Westmead Hospital, Sydney, NSW Australia
| | - Clare Toms
- Surgical Outcomes Research Centre (SOuRCe), The University of Sydney and Sydney Local Health District, Sydney, NSW Australia
| | - Charbel Sandroussi
- Surgical Outcomes Research Centre (SOuRCe), The University of Sydney and Sydney Local Health District, Sydney, NSW Australia
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and University of Sydney, Sydney, NSW Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW Australia
- Department of Upper Gastrointestinal and Hepatobiliary Surgery, Royal Prince Alfred Hospital, Sydney, NSW Australia
| | - David A. Yeo
- Surgical Outcomes Research Centre (SOuRCe), The University of Sydney and Sydney Local Health District, Sydney, NSW Australia
- Department of Upper Gastrointestinal and Hepatobiliary Surgery, Royal Prince Alfred Hospital, Sydney, NSW Australia
| | - Daniel Steffens
- Surgical Outcomes Research Centre (SOuRCe), The University of Sydney and Sydney Local Health District, Sydney, NSW Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW Australia
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Parikh N, Langfitt MK, Shilt J, Bullock GS, Shields JS. Closing Time: One Last Call for Patient Preference. Arthroplast Today 2022; 15:1-5. [PMID: 35342782 PMCID: PMC8943337 DOI: 10.1016/j.artd.2022.02.022] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 02/13/2022] [Accepted: 02/15/2022] [Indexed: 11/17/2022] Open
Abstract
Background Wound closure method in total hip and knee arthroplasty is a controversial topic with no differences in clinical outcomes between surgical staples (SS) and subcutaneous sutures with Dermabond (SCD). When clinically appropriate, providers should focus more on what the patient may prefer. This study aimed to collect data on patient preference between SS and SCD and analyze differences in preference based on gender and previous surgical histories. Methods Patients were surveyed on their wound closure preferences prior to surgery. The handout given collected preference and patient demographics. Risk ratios and risk difference with 95% confidence intervals (95% CI) were calculated along with Firth-corrected logistic regressions. Results A total of 163 participants were analyzed (53% female) (average age = 63.8 years), in which 12 participants selected SS as their preferred method. Males demonstrated no difference in relative risk (risk ratio: 2.3 [95% CI: 0.7, 7.3], P = .150) or absolute risk (risk difference: 5.9 [-2.2, 14.1], P = .156) in choosing SS over SCD. Patients that previously sustained SS for other surgeries demonstrated no difference in adjusted odds (adjusted: 0.9 [95% CI: 0.2, 3.2], P = .839) in choosing SS over SCD. Conclusion More patients favored SCD over SS. There was no difference in preferences based on gender or previous surgical history. Current literature shows that successful wound closure is achieved with minimized risks for infection and other complications using both methods. Providers should adopt a patient-centric approach and perform the closure method that most patients prefer when medically warranted.
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Affiliation(s)
- Nihir Parikh
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Maxwell K Langfitt
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - John Shilt
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Garrett S Bullock
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Centre for Sport, Exercise, and Osteoarthritis Research Versus Arthritis, University of Oxford, Oxford, UK
| | - John S Shields
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Salyer CE, Thompson J, Hoffman A, Burstein MD, Enochs P, Watkins BM, Kuethe J, Goodman MD. Multisite study of Titan SGS stapler in longitudinal gastric resection. Surg Endosc 2022. [PMID: 35080675 DOI: 10.1007/s00464-022-09051-x] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 01/11/2022] [Indexed: 11/16/2022]
Abstract
Background Standardization of the laparoscopic sleeve gastrectomy procedure is needed to improve patient outcomes. A single-fire 23 cm stapler was developed to streamline the operation. Comparative testing conducted on excised human tissue has demonstrated the superiority of the novel Titan SGS stapler to two commonly utilized commercial devices in both staple line integrity and burst pressure. We hypothesized that the stapler would be safe and effective in creating longitudinal gastric resections in human patients. Methods 61 patients were enrolled to undergo gastric resection with the Titan SGS stapler. Perioperative interventions and post-operative adverse events were recorded. Upper GI study was completed on post-operative day 1, and patients were followed for 6 weeks post-operatively to determine any subacute device-related adverse events. Results Surgeon feedback for intraoperative device utilization and post-operative gastric pouch shape were positive. Adverse events were found to be mild, limited, and generally well-known effects of bariatric surgery. One episode of post-operative hemorrhage required surgical takeback, with no criminal bleeding vessel identified. Conclusion The Titan SGS stapler is both safe and effective in sleeve gastrectomy pouch creation.
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Salyer C, Spuzzillo A, Wakefield D, Gomaa D, Thompson J, Goodman M. Endocutter Staple Height Auto-adjusts to Tissue Thickness. J Surg Res 2021; 267:705-711. [PMID: 34364256 DOI: 10.1016/j.jss.2021.06.024] [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: 02/02/2021] [Revised: 06/04/2021] [Accepted: 06/10/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Surgeon choice of the appropriate staple height has been cited as a factor in the mechanical integrity of a staple line. However, tissue measured at the industry standard 8 g/mm2 is usually thicker than the formed staple height of the staples that hold it together. This means that the pressure that the staples apply must be greater than 8g/mm2. Additionally, formed staple heights in tissue may be different than formed staple heights of the same cartridge type when fired without tissue. This means that there is likely a compressive limit to the individual staples deployed by the stapling system. The purpose of this study is to establish the degree to which staple heights of endocutter staples auto-adjust to tissue and the compressive limit to tissue that this infers. MATERIALS AND METHODS Excised gastric remnants from laparoscopic sleeve gastrectomy were measured for tissue thickness at different external pressures. An optimized experimental staple line was then created in parallel to the clinical staple line. The doubly-stapled gastric sliver then underwent computed tomography with solid modeling software to measure staple heights. RESULTS Staple heights fired in gastric tissue were significantly different than industry labelled and control staple heights. Clinical staple heights were significantly shorter than measured tissue thickness at 8 g/mm2. Staple height more closely approximated tissue thickness under 15 g/mm2 of pressure, rather than the 8 g/mm2 loading pressure used by industry for tissue thickness range labelling. CONCLUSIONS Staples deployed in human gastric tissue are taller than commercial labelling. The closed staple height corresponds to tissue thickness under 15g/mm2 of pressure, not the labelled staple height. These results demonstrate that staple heights from modern endocutter staplers adjust to tissue, approximating a maximum compressive force just above 15g/mm2.
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Affiliation(s)
- Christen Salyer
- Division of Research, Section of General Surgery, Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Anthony Spuzzillo
- Section of General Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Devin Wakefield
- Section of General Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Dina Gomaa
- Section of General Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Jonathan Thompson
- Section of General Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio; Standard Bariatrics, Inc. Cincinnati, Ohio
| | - Michael Goodman
- Section of General Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio.
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Salyer C, Spuzzillo A, Wakefield D, Gomaa D, Thompson J, Goodman M. Assessment of a novel stapler performance for laparoscopic sleeve gastrectomy. Surg Endosc 2021; 35:4016-21. [PMID: 32749610 DOI: 10.1007/s00464-020-07858-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 07/28/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Optimal stapler selection during laparoscopic sleeve gastrectomy requires careful balance between tissue compression, hemostasis, and mechanical integrity. Junctions along a staple line can further increase the risks of technical or mechanical staple line failures. The aim of this study was to compare two commonly utilized laparoscopic linear gastrointestinal staplers (Ethicon, Medtronic) with a novel linear stapler (Titan) designed to perform a sleeve gastrectomy with a single stapler firing. METHODS Excised gastric remnants from laparoscopic sleeve gastrectomy were utilized and tissue thickness was measured from fundus to antrum. An optimized experimental staple line was then created. The greater curve remnant was insufflated to determine the staple line burst pressure and location. The doubly stapled (clinical and experimental) gastric specimen underwent staple analysis for junctional location, malformation, and height. RESULTS The Titan stapler withstood a significantly higher burst pressure than both Ethicon and Medtronic linear cutting staplers. While the Medtronic and Ethicon staplers had a similar percentage of staples in junctions, the Titan stapler has no junctions. In considering the formation of all staples outside of junctions, the Medtronic and Titan staplers had no difference in percentage of malformed staples, while the Ethicon stapler had a significantly higher percentage. Additionally, there were no differences in mismatch between staple height and tissue thickness between experimental groups. CONCLUSIONS The Titan stapler conveys the mechanical benefits of higher burst pressure with the advantage of single load functionality. This single staple load eliminates staple line junctions without sacrificing the integrity of staple formation.
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Lee BH, Yun SS, Kim MK, Jung HK, Lee DS, Kim HJ. Rationale and surgical technique of laparoscopic left lateral sectionectomy using endoscopic staples. Ann Surg Treat Res 2014; 87:66-71. [PMID: 25114885 PMCID: PMC4127897 DOI: 10.4174/astr.2014.87.2.66] [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: 12/10/2013] [Revised: 04/03/2014] [Accepted: 04/04/2014] [Indexed: 01/22/2023] Open
Abstract
Purpose Laparoscopic left lateral sectionectomy (LLLS) has been widely accepted due to benefits of minimally invasive surgery. Some surgeons prefer to isolate glissonian pedicles to segments II and III and to control individual pedicles with surgical clips, whereas opt like to control glissonian pedicles simultaneously using endoscopic stapling devices. The aim of this study was to find the rationale of LLLS using endoscopic staples. Methods We retrospectively analyzed and compared the clinical outcomes (operation time, drainage length, transfusion, hospital stay, and complication rate) of 35 patients that underwent LLLS between April 2004 and February 2012. Patients were dichotomized by surgical technique based on whether glissonian pedicles were isolated and controlled (the individual group, n = 21) or controlled using endoscopic staples at once (the batch group, n = 14). Results Mean operation time was 265.3 ± 21.3 minutes (mean ± standard deviation) in the individual group and 170 ± 22.9 minutes in the batch group. Operation time in the batch group was significantly shorter than the individual group (P = 0.007). Mean drainage length was 4.8 ± 1.6 and 2.6 ± 1.5 days in the individual and the batch group. There was significantly shorter in the batch group, also (P = 0.006). No transfusion was required in the batch group, but 4 patients in the individual group needed transfusion. Mean hospital stay was 10.7 ± 1.1 and 9.4 ± 0.8 days in the individual and the batch groups (P = 0.460). There were no significant complications or mortality in both groups. Conclusion LLLS using endoscopic staples (batch group) was found to be an easier and safer technique without morbidity or mortality.
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Affiliation(s)
- Beom Hui Lee
- Department of Surgery, Yeungnam University Medical Center, Daegu, Korea
| | - Sung-Su Yun
- Department of Surgery, Yeungnam University Medical Center, Daegu, Korea
| | - Man Ki Kim
- Department of Surgery, Yeungnam University Medical Center, Daegu, Korea
| | - Hwa-Kyung Jung
- Department of Surgery, Yeungnam University Medical Center, Daegu, Korea
| | - Dong-Shik Lee
- Department of Surgery, Yeungnam University Medical Center, Daegu, Korea
| | - Hong-Jin Kim
- Department of Surgery, Yeungnam University Medical Center, Daegu, Korea
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