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Vishwakarma AK, Sharma NK, Dhiman NK, Singh S, Jaiswara C, Swaraj S. Exploring the supremacy of microvascular coupling devices for arterial anastomosis in terms of added expeditiousness, safety concerns: A systematic review. J Oral Biol Craniofac Res 2024; 14:116-125. [PMID: 38313578 PMCID: PMC10835319 DOI: 10.1016/j.jobcr.2024.01.005] [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: 10/03/2023] [Revised: 12/23/2023] [Accepted: 01/09/2024] [Indexed: 02/06/2024] Open
Abstract
Background Arterial anastomoses are still most commonly performed using orthodox hand sewing technique. Various rationale such as non-pliable, atherosclerotic, thick-walled or irradiated vessels limit the competency of coupler devices for arterial micro-anastomosis. Microvascular coupling devices (MCD) are well known for venous anastomoses but arterial MCD have relatively been less navigated in reported literatures. This review outlines the current applications, troubleshooting, safety and efficiency of arterial MCD in free flaps. Methods Comprehensive search of electronic databases (PUBMED/MEDLINE) in accordance with PRISMA guideline was performed. Data were extracted and collected in four groups of standardised variables. Results Out of a total of 263 identified articles, 38 studies were analysed and 16 amidst these were included in final data synthesis. Included studies contained a combined total of 2416 patients who went through 521 arterial and 2460 venous anastomoses using 3 M/Synovis coupling devices. Among all coupled arterial anastomoses, 407 were conducted in head and neck free tissue transfer and 114 were performed in breast reconstruction. The aggregate coupled arterial micro-anastomosis success rate reported was 90.01 % (469/521). Only 9.98 % (52 out of 521) manifested pooled incidence of troubleshooting, thrombosis or flap failure. Conclusion Microsurgeons are resisting the frequent use of arterial coupling devices owing to inherent arterial characteristics, but with suitable vessel selection, arterial coupling may be a powerful tool and can be executed in safe, expeditious and reliable fashion. This study embellishes collaborative suggestions and troubleshooting issues related to arterial coupling, however further assessment would be required with controlled trials.
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Affiliation(s)
| | - Naresh Kumar Sharma
- Unit of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Neeraj Kumar Dhiman
- Unit of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Shankar Singh
- Govt. District Hospital, Neemkathana, Rajasthan, India
| | - Chandresh Jaiswara
- Unit of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Sadhana Swaraj
- Consultant Orthodontist (Private practitioner), Uttar Pradesh, India
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Mei S, Zhang M, Ye F, Qiu W, Quan J, Zhuang M, Wang X, Tang J. Persistent descending mesocolon as a vital risk factor for anastomotic failure and prolonged operative time for sigmoid colon and rectal cancers. World J Surg Oncol 2023; 21:199. [PMID: 37420246 DOI: 10.1186/s12957-023-03091-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 04/13/2023] [Accepted: 06/29/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND The diagnostic criteria and effect of persistent descending mesocolon (PDM) on sigmoid and rectal cancers (SRCs) remain controversial. This study aims to clarify PDM patients' radiological features and short-term surgical results. METHOD From January 2020 to December 2021, radiological imaging data from 845 consecutive patients were retrospectively analyzed using multiplanar reconstruction (MRP) and maximum intensity projection (MIP). PDM is defined as the condition wherein the right margin of the descending colon is located medially to the left renal hilum. Propensity score matching (PSM) was used to minimize database bias. The anatomical features and surgical results of PDM patients were compared with those of non-PDM patients. RESULTS Thirty-two patients with PDM and 813 patients with non-PDM were enrolled into the study who underwent laparoscopic resection. After 1:4 matching, patients were stratified into PDM (n = 27) and non-PDM (n = 105) groups. The lengths from the inferior mesenteric artery (IMA) to the inferior mesenteric vein (1.6 cm vs. 2.5 cm, p = 0.001), IMA to marginal artery arch (2.7 cm vs. 8.4 cm, p = 0.001), and IMA to the colon (3.3 cm vs. 10.2 cm, p = 0.001) were significantly shorter in the PDM group than those in the non-PDM group. The conversion to open surgery (11.1% vs. 0.9%, p = 0.008), operative time (210 min vs. 163 min, p = 0.001), intraoperative blood loss (50 ml vs. 30 ml, p = 0.002), marginal arch injury (14.8% vs. 0.9%, p = 0.006), splenic flexure free (22.2% vs. 3.8%, p = 0.005), Hartmann procedure (18.5% vs. 0.0%, p < 0.001) and anastomosis failure (18.5% vs. 0.9%, p = 0.001) were significantly higher in the PDM group. Moreover, PDM was an independent risk factor for prolonged operative time (OR = 3.205, p = 0.004) and anastomotic failure (OR = 7.601, p = 0.003). CONCLUSION PDM was an independent risk factor for prolonged operative time and anastomotic failure in SRCs surgery. Preoperative radiological evaluation using MRP and MIP can help surgeons better handle this rare congenital variant.
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Affiliation(s)
- Shiwen Mei
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. No, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Mingguang Zhang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. No, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Feng Ye
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Wenlong Qiu
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. No, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Jichuan Quan
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. No, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Meng Zhuang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. No, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Xishan Wang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. No, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Jianqiang Tang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. No, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China.
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Rino Y, Aoyama T, Maezawa Y, Hashimoto I, Sawazaki S, Kazama K, Numata M, Tamagawa H, Sato T, Yamada T, Oshima T, Saito A, Yukawa N. Does Intestinal Peristalsis Cause Suture Failure After Instrument Suture? In Vivo 2023; 37:1886-1889. [PMID: 37369506 DOI: 10.21873/invivo.13281] [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: 04/26/2023] [Revised: 05/12/2023] [Accepted: 05/15/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND/AIM Gastrectomy with lymphadenectomy is a standard treatment for gastric cancer. Anastomotic leakage remains a potentially fatal complication of gastrectomy. Forceful stapler extraction may cause anastomotic complications. We focused on the duodenal peristalsis, as we hypothesized that it might cause forceful stapler extraction. We then retrospectively investigated duodenal peristalsis and reviewed videos of Da Vinci system cases to clarify the relationship between peristalsis and anastomotic complications. PATIENTS AND METHODS Forty-nine cases with stored videos of laparoscopic surgery using the Da Vinci system from 2015 to March 2021 were included. Peristalsis was defined by repeated contraction and expansion that was clearly visible three or more times in a row. The duodenum was investigated because it is frequently observed during gastrectomy. Suture failure was evaluated in cases with and without peristalsis. RESULTS The study population included 49 patients [male, n=32; female, n=17; median age, 71 (42-82) years]. Duodenal peristalsis was observed in 14 (28.6%) cases. Three patients experienced complications. A comparative study of cases with and without complications showed significant peristalsis in cases with complications (p=0.0198). CONCLUSION A new definition to evaluate duodenal peristalsis was established. Anastomotic complications were significantly more frequent in cases with peristalsis (p=0.0198). Our results suggest the utility of manual over-sewing or the use of reinforcement material.
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Affiliation(s)
- Yasushi Rino
- Department of Surgery, Yokohama City University, School of Medicine, Yokohama, Japan;
| | - Toru Aoyama
- Department of Surgery, Yokohama City University, School of Medicine, Yokohama, Japan
| | - Yukio Maezawa
- Department of Surgery, Yokohama City University, School of Medicine, Yokohama, Japan
| | - Itaru Hashimoto
- Department of Surgery, Yokohama City University, School of Medicine, Yokohama, Japan
| | - Sho Sawazaki
- Department of Surgery, Yokohama City University, School of Medicine, Yokohama, Japan
| | - Keisuke Kazama
- Department of Surgery, Yokohama City University, School of Medicine, Yokohama, Japan
| | - Masakatsu Numata
- Department of Surgery, Yokohama City University, School of Medicine, Yokohama, Japan
| | - Hiroshi Tamagawa
- Department of Surgery, Yokohama City University, School of Medicine, Yokohama, Japan
| | - Tsutomu Sato
- Gastroenterological Center, Medical Center, Yokohama, Japan
| | - Takanobu Yamada
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Takashi Oshima
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Aya Saito
- Department of Surgery, Yokohama City University, School of Medicine, Yokohama, Japan
| | - Norio Yukawa
- Department of Surgery, Yokohama City University, School of Medicine, Yokohama, Japan
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Mor E, Assaf D, Laks S, Benvenisti H, Ben-Yaacov A, Zohar N, Schtrechman G, Hazzan D, Shacham-Shmueli E, Perelson D, Adileh M, Nissan A. The impact of gastrointestinal anastomotic leaks on survival of patients undergoing cytoreductive surgery and heated intraperitoneal chemotherapy. Am J Surg 2021:S0002-9610(21)00222-1. [PMID: 33832737 DOI: 10.1016/j.amjsurg.2021.03.061] [Citation(s) in RCA: 3] [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: 12/27/2020] [Revised: 02/15/2021] [Accepted: 03/28/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Gastrointestinal (GI) leaks after cytoreductive surgery and hyperthermic Intraperitoneal Chemotherapy (CRS/HIPEC) is a known life-threatening complication that may alter patients' outcomes. Our aim is to investigate risk factors associated with GI leaks and evaluate the impact of GI leaks on patient's oncological outcomes. METHODS A retrospective analysis of perioperative and oncological outcomes of patients with and without GI leaks after CRS/HIPEC. RESULTS Out of 191 patients included in this study, GI leaks were identified in 17.8% (34/191) of patients. Small bowel anastomoses were the most common site (44%). Most of the GI leaks were managed conservatively and re-operation was needed in 44.1% of cases. Univariate analysis identified higher PCI (p = 0.03), higher number of packed cells transfused (p = 0.036), pelvic peritonectomy (p = 0.013), high number of anastomoses (p = 0.003) and colonic resection (p = 0.042) as factors associated with GI leaks. Multivariate analysis identified stapled anastomoses (OR 2.59, p = 0.001) and pelvic peritonectomy (OR 2.33, p = 0.044) as independent factors associated with GI leaks. Disease-free survival tended to be worse in the leak group but did not reach statistical significance (p = 0.235). The 3- and 5-year OS was 73.2% and 52.9% in the leak group compared to 75.8% and 73.2% in the non-leak group (p = 0.236). CONCLUSIONS GI leak showed no impact on overall and disease free survival after CRS/HIPEC.Avoidance of stapled reconstruction in high risk patients with high tumor burden and large number of anastomoses may yield improved outcomes.
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Pafitanis G, Nicolaides M, O'Connor EF, Raveendran M, Ermogenous P, Psaras G, Rose V, Myers S. Microvascular anastomotic arterial coupling: A systematic review. J Plast Reconstr Aesthet Surg 2021; 74:1286-1302. [PMID: 33551362 DOI: 10.1016/j.bjps.2020.12.090] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 06/17/2020] [Revised: 11/23/2020] [Accepted: 12/22/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION There are several reasons microsurgeons may not use a coupler device in arterial anastomosis: may be thick-walled, non-pliable due to atherosclerotic calcification or present vessel geometrical discrepancies. This review summarises the current applications, efficacy and troubleshooting of microvascular coupler devices in arterial end-to-end anastomosis. METHODS A systematic review of the literature was performed in November 2020 across 4 electronic databases and in accordance with the PRISMA guidelines. All studies comprised the data synthesis that reported the use of a microvascular coupler device for arterial end-to-end anastomosis. Data were extracted and collected in three groups of standardised variables: study, anastomosis-related and technical characteristics. RESULTS Out of the 7,690 articles identified, 20 were included in the final data synthesis. Included studies involved a total of 1639 patients, who underwent 670 arterial and 1,124 venous anastomoses. Out of all arterial anastomoses, 351 were performed in free tissue transfers in head and neck, 117 in breast, 4 in upper extremity and 5 in lower extremity reconstruction, whereas the remaining were not specified. The total arterial coupler anastomosis success rate reported was 92.1% (617/670). Fifty-three (8%) arterial anastomoses were reported to result in either troubleshooting events or intra- or post-operative failures, most being reported in extremity reconstructions. CONCLUSIONS Arterial coupling is not widespread with predominant use in head and neck and chest reconstructions, and total reported efficacy of 92.1%. Microsurgeons are reluctant to routinely use current widespread coupler devices as a result of inherent arterial characteristics. This study delivered collective recommendations, 'do's and don'ts' of microvascular arterial coupling.
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Affiliation(s)
- Georgios Pafitanis
- Group for Academic Plastic Surgery, The Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Department of Plastic Surgery, Guy's and St Thomas' Hospital, London, UK; Department of Orthoplastics Surgery, Kings College Hospital, London, UK; Department of Plastic Surgery, Emergency Care and Trauma Division, The Royal London Hospital, Bart's Health NHS Trust, London, UK.
| | - Marios Nicolaides
- Group for Academic Plastic Surgery, The Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Department of Plastic Surgery, Emergency Care and Trauma Division, The Royal London Hospital, Bart's Health NHS Trust, London, UK
| | - Edmund Fitzgerald O'Connor
- Group for Academic Plastic Surgery, The Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Department of Plastic Surgery, Guy's and St Thomas' Hospital, London, UK; Department of Orthoplastics Surgery, Kings College Hospital, London, UK
| | - Maria Raveendran
- Group for Academic Plastic Surgery, The Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - George Psaras
- Plastic Surgery Department, University of the Witwatersrand, Johannesburg, South Africa
| | - Victoria Rose
- Group for Academic Plastic Surgery, The Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Department of Plastic Surgery, Guy's and St Thomas' Hospital, London, UK; Department of Orthoplastics Surgery, Kings College Hospital, London, UK
| | - Simon Myers
- Group for Academic Plastic Surgery, The Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Department of Plastic Surgery, Emergency Care and Trauma Division, The Royal London Hospital, Bart's Health NHS Trust, London, UK
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Rink AD, Kienle P, Aigner F, Ulrich A. How to reduce anastomotic leakage in colorectal surgery-report from German expert meeting. Langenbecks Arch Surg 2020; 405:223-232. [PMID: 32189067 DOI: 10.1007/s00423-020-01864-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 12/22/2019] [Accepted: 03/05/2020] [Indexed: 01/16/2023]
Abstract
AIMS Anastomotic leakage is one of the most worrisome complications in colorectal surgery. An expert meeting was organized to discuss and find a consensus on various aspects of the surgical management of colorectal disease with a possible impact on anastomotic leakage. METHODS A three-step Delphi-method was used to find consensus recommendations. RESULTS Strong consensus was achieved for the use of mechanical bowel preparation and oral antibiotics prior to colorectal resections, the abundance of non-selective NSAIDs, the preoperative treatment of severe iron deficiency anemia, and for attempting to improve the patients' general performance in the case of frailty. Concerning technical aspects of rectal resection, there was a strong consensus in regard to routinely mobilizing the splenic flexure, to dividing the inferior mesenteric vein, and to using air leak tests to check anastomotic integrity. There was also a strong consensus on not to oversew the stapled anastomoses routinely, to use protective ileostomies for low rectal and intersphincteric, but not for high-rectal anastomoses. Furthermore, a consensus was reached in regard to using CT-scans with rectal contrast enema to evaluate suspected anastomotic leakage as well as measuring C-reactive protein routinely to monitor the postoperative course after colorectal resections. No consensus was found concerning the indication and technique for testing bowel perfusion, the routine use of endoscopy to check the integrity of the anastomosis, the placement of transanal drains for rectal anastomoses and the management of anastomotic leakage with peritonitis. CONCLUSION Consensus could be found for several practice details in the perioperative management in colorectal surgery that might have an influence on anastomotic leakage.
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Affiliation(s)
- Andreas D Rink
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Klinikum Leverkusen gGmbH, Am Gesundheitspark 11, 51375, Leverkusen, Germany.
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany.
| | - Peter Kienle
- Klinik für Allgemein- und Viszeralchirurgie, Theresienkrankenhaus und St. Hedwig-Klinik GmbH, Mannheim, Germany
| | - Felix Aigner
- Chirurgische Klinik Campus Charité Mitte/Campus Virchow, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Alexis Ulrich
- Chirurgische Klinik I, Rheinland Klinikum GmbH, Lukaskrankenhaus Neuss, Neuss, Germany
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Räsänen M, Renkonen-Sinisalo L, Carpelan-Holmström M, Lepistö A. Low anterior resection combined with a covering stoma in the treatment of rectal cancer reduces the risk of permanent anastomotic failure. Int J Colorectal Dis 2015; 30:1323-8. [PMID: 26111635 DOI: 10.1007/s00384-015-2291-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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] [Accepted: 06/13/2015] [Indexed: 02/04/2023]
Abstract
PURPOSE The adoption of the total mesorectum excision technique and circular stapler devices has enabled the performance of ultralow colorectal anastomosis in rectal cancer surgery. However, rupture of the anastomosis still usually leads to a permanent stoma. The aim of this study was to analyze the cumulative failure rate and risk factors associated with reversal of colorectal or coloanal anastomosis after sphincter-saving surgery for rectal cancer, using standardized surgical regimen with the routine use of covering stoma. Our secondary interest was the feasibilities of redo surgery after failure. METHODS This was a retrospective study with 579 consecutive rectal cancer patients operated on at Helsinki University Hospital, Helsinki, Finland during 2005-2011. Data were collected from patient records. After exclusions, 273 consecutive patients treated with a low anterior resection with a protective stoma were included. RESULTS In total, 23 out of 271 (8.5 %) of the colorectal/coloanal anastomoses were converted to a permanent stoma. In five patients (1.8 %), the covering stoma was not closed. The permanent stoma rate was thus 28 out of 271 (10.3 %). The risk factors associated with failure were the tumor distance from the anal verge (p = 0.03), coloanal anastomosis (p = 0.003), early anastomotic complication (p < 0.001), anastomotic fistula (p < 0.001), anal incontinence (p = 0.05), and local recurrence (p < 0.001). CONCLUSIONS Our standardized surgical regimen with a covering stoma in low anterior resection for rectal cancer resulted in a minor anastomosis failure rate and a low risk of permanent stoma.
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Affiliation(s)
- Minna Räsänen
- Colorectal Surgery, Abdominal Center, Helsinki University Hospital, Kasarmikatu 11-13, Pl 263, 00029, Helsinki, Finland. .,University of Helsinki, Helsinki, Finland.
| | - Laura Renkonen-Sinisalo
- Colorectal Surgery, Abdominal Center, Helsinki University Hospital, Kasarmikatu 11-13, Pl 263, 00029, Helsinki, Finland. .,Research Programs Unit, Genome-Scale Biology, University of Helsinki, Helsinki, Finland.
| | - Monika Carpelan-Holmström
- Colorectal Surgery, Abdominal Center, Helsinki University Hospital, Kasarmikatu 11-13, Pl 263, 00029, Helsinki, Finland.
| | - Anna Lepistö
- Colorectal Surgery, Abdominal Center, Helsinki University Hospital, Kasarmikatu 11-13, Pl 263, 00029, Helsinki, Finland.
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Pommergaard HC, Achiam MP, Burcharth J, Rosenberg J. Decreased leakage rate of colonic anastomoses by tachosil coating: an experimental study. Int Surg 2014; 99:359-63. [PMID: 25058765 DOI: 10.9738/INTSURG-D-13-00093.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Colorectal anastomotic coating has been proposed as a means to lower the leakage rate. Prior to clinical testing, coating materials need thorough experimental evaluation to ensure safety and efficacy. The aim of this study was to evaluate Tachosil as an anastomotic coating agent. Technically insufficient colon anastomoses were created in 80 C57BL/6 mice, and in half of the animals the anastomoses were covered with Tachosil. The animals were examined for clinical signs of anastomotic leakage, and the breaking strength of the anastomoses was evaluated. The number of leakages was reduced by Tachosil coating (10/40 versus 20/40 in controls; P=0.037). However, more cases of large bowel obstruction were found in the Tachosil group (12/40 versus 0/40 in controls; P<0.0005). Breaking strength was comparable between the Tachosil and control groups (0.49 N versus 0.52 N, respectively; P=0.423). Clinical studies are needed to clarify the efficacy of Tachosil anastomotic coating.
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