The feasibility of bipolar tissue sealer for appendix stump closure.

BACKGROUND: Appendiceal stump closure is a highly important step in laparoscopic appendectomy, especially for post-operative complications. The aim of this study is to compare the effects of suture ligation and bipolar tissue sealer techniques on burst pressure using flesh appendectomy specimens. MATERIAL AND METHODS: Appendectomy specimens of 32 patients with grade I-II disease were included in the study. Perforated or necrotic appendices and specimens ineligible for pressure measurement were excluded from the study. Appendiceal stumps of 16 patients in group 1 were double-ligated with 2/0 polyglactin sutures, then appendectomy was performed between these sutures. In group 2, the management of the stump was performed through single ligation with polyglactin suture, followed by appendectomy using a bipolar tissue sealing device. Burst pressures were recorded for all specimens. RESULTS: There were no differences between groups in terms of age and sex. There was no significant difference between the two groups in terms of burst pressure (p = 0.92). Also, no significant difference was found between groups in terms of localization of the perforation (p > 0.05). CONCLUSION: Bipolar tissue sealer achieves safe stump closure with satisfactory burst pressure values. Based on this, using bipolar tissue sealer for appendiceal stump closure in appendicitis may be safe and reliable.

Effects of a Glutamine Enema on Anastomotic Healing in an Animal Colon Anastomosis Model.

PURPOSE: Anastomotic leakage in colorectal surgery is a very important issue. Although many studies have shown the positive effects of enteral glutamine (Gln) on anastomotic healing, none has assessed the effects of administering Gln via an enema for anastomotic healing. To fill this study gap, this study investigated the intraluminal effect of administration of Gln enema on the healing of colonic anastomosis in a rat model. METHODS: Thirty Wistar albino rats were divided into three groups containing 10 rats each and were subjected to distal left colon transection and anastomosis. Postoperatively, group I (the control group) was administered no treatment, group II was administered daily placebo enemas containing physiological saline, and group III was administered daily 2% L-Gln enemas. After sacrifice on postoperative day 5, anastomotic healing, burst pressure, tissue hydroxyproline levels, and histological parameters were measured, and group values were compared via statistical analysis. RESULTS: Group III was found to have the highest mean bursting pressure and tissue hydroxyproline levels and the lowest mean ischemia score. While the values of these parameters were not found to differ significantly among the groups, the lack of significance may have been due to the limited number of subjects examined. CONCLUSION: Administration of a Gln enema may have a positive effect on anastomosis in terms of bursting pressure and histopathological parameters. Future research should examine administration of a preoperative Gln enema as a means of decreasing the traumatic effects of the enema and identifying its applicability in surgical practice.

The effect of serosal suture reinforcement on burst pressure in sleeve gastrectomy specimens.

PURPOSE: Staple-line leak is a life-threatening complication of laparoscopic sleeve gastrectomy. Reinforcement materials have been reported to lower the risk of staple-line bleeding, but their effects on leak risk have not been elucidated. The aim of this study was to compare the effects of 2 supportive techniques on burst pressures in sleeved gastrectomy specimens. METHODS: A total of 30 patients who underwent laparoscopic sleeve gastrectomy were evaluated. The resected sleeve gastrectomy specimens were categorized into 3 groups: group 1 had no extra support in the staple-line, group 2 had interrupted serosal suture on the staple-line, and group 3 had serosal suture on staple-line junction points. The endpoint was the first detectable leakage, at which point the leak pressure and anatomic site of the leakage were recorded. RESULTS: A total of 30 sleeved gastrectomy specimens were included (each group included 10 specimens). There were no differences between groups in terms of age, sex, and body mass index. The leak pressure was significantly higher (56.2±6.4 mm Hg) in group 2 (P<0.01). Leaks occurred significantly more frequently in the staple-line than in the staple-line junction points (P<0.01). CONCLUSIONS: Interrupted serosal suture significantly increased the burst pressure. Increases in intraluminal pressure are known to be significant in leak etiology. Thus, we concluded that interrupted serosal suture may be beneficial in the prevention of leaks.

What do we leave behind after neartotal and subtotal thyroidectomy: just the tissue or the disease?

Selection of multinodular goiter (MNG) surgery procedure is stilll under discussion. Subtotal thyroidectomy (STT) and neartotal thyroidectomy (NTT) are preferred surgical procedures. However, it is uncertain whether the remnant tissue contains pathological findings or not after these procedures. We aimed to evaluate and comparison the pathologic findings in remnant tissue after NTT and STT. Thyroid tissue samples of 50 patients who underwent TT for MNG disease between January 2010 and August 2011 in our clinic were evaluated. Before the dissection of the thyroid tissue subtotal and neartotal margins were marked in both right and left lobes. After the resection of the specimen, the tissue was excised from the subtotal and neartotal margin marked during the surgery. The pathologic findings of the main tissue, the residual subtotal and neartotal tissues were evaluated and compared. All patients were followed-up 1 year. 43 (86%) females and 7 (14%) males with an average age of 50.5 (23-77) were included in the study. Incidental papillary thyroid cancer was detected in 5 patients (10%). Pathologic findings were present in 31 patients (62%) of subtotal residual tissue and 28 of the patients (56%) of neartotal residual tissue. Papillary microcarcinoma was detected in 3 (9.7%) of subtotal residual tissues and 2 (7.1%) of neartotal residual tissues. There is no significant difference between subtotal and neartotal tissues in terms of existence of pathological findings (p>0.05). There is no significant difference between the neartotal and subtotal residual tissues contralateral of dominant nodule (p>0.05). 2 of the patients (4%) had temporary hypocalcemia, 1 patient (2%) had seroma and 1 patient (2%) had recurrent laryngeal nerve injury. There are high rates of microscopic pathological findings on residual tissues both after STT and NTT. The neartotal and subtotal residual tissues contralateral to the large nodule also had high levels of pathologic findings.

Comparison of four different methods in staple line reinforcement during laparascopic sleeve gastrectomy.

The main early complications of Laparascopic Sleeve Gastrectomy are bleeding and gastric leakage. Many reinforcement methods are performed in order to reduce these complications. In this prospective, randomized study, we compared four different techniques to evaluate staple line reinforcement in Laparascopic Sleeve Gastrectomy. Between January 2012 and May 2013, 65 patients were prospectively randomized into four groups in which different techniques were used in handling the staple line during Laparascopic Sleeve Gastrectomy. Of the four groups, there wasn't any reinforcement used on 15 patients during LSG (group 1), continuous serosal 3-0 prolene sutures were used on 16 patients for staple line reinforcement (group 2), staple line was supported with v-loc suture in 16 patients (group 3), and 18 patients had Tisseel fibrin sealant applied throughout the staple line (group 4). 40 of 65 patients were females, the mean age was 36.8 years (20-58 years), and the mean BMI was 49.2 (41-60 kg/m²). Characteristics of patients among groups were similar. There wasn't any significant difference found between groups for BMI. Gastric leakage was detected from the staple line in 2 patients of the v-loc group. According to our results, we demonstrated that good results can be obtained without any reinforcement. Reinforcement with propylene suture only prolongs the operation time, and tissue fibrin sealent increases the cost. In conclusion, we should be more careful using v-loc sutures, and further series with larger numbers are needed to test v-loc.