An alternative linear stapling technique for performing Roux-en-Y anastomosis.

BACKGROUND: The use of stapling devices for performing gastrointestinal anastomosis has gained wide acceptance in the last decade. Linear cutting devices have been used routinely during gastrointestinal operations in our hospital since 1992. However, we still have shortage of stapling devices due to cost reduction politics. METHODS: We propose a modification of the standard technique in order to reduce the number of devices used. Our technique employs a single stapled including the section of the jejunum and the side-to-side jejunoanastomosis. RESULTS: We have used this technique for 1 year without complications related to the stapled anastomosis. CONCLUSIONS: This technique may reduce the time of reconstruction of Roux-en-Y anastomosis without interfering in its final result. This modified technique may be useful in hospitals with reduced economic resources.

Suturas colónicas: variantes técnicas y resultados / Results and variety on colonic anastomosis

Antecedentes: Desde los comienzos de la cirugía moderna se ha investigado en la búsqueda de la técnica de sutura ideal para efectuar anastomosis intestinales. Objetivos: Demostrar que: 1) Las suturas continuas en las anastomosis intestinales tienen idéntico resultado que las suturas a puntos separados, son más rápidas y económicas. 2) Los materiales sintéticos reabsorbibles permiten obtener resultados similares a los alcanzados con material irreabsorbible como el lino quirúrgico. Diseño: Comparativo, prospectivo, transversal y experimental. Población y muestra: Se incluyeron todas las anastomosis íleo-colónicas, colocolónicas, ileorectales y colorectales intraperitoneales por cualquier patología, programadas o de urgencia. Se compararon 3 técnicas anastomóticas: Puntos separados de lino en el grupo I, que incluyó 18 casos; Puntos separados de material sintético reabsorbible en el grupo II, que incluyó 19 pacientes; Sutura continua de material sintético reabsorbible en el grupo M, que también se integró con 19 enfermos. Material y método: Se analizaron la proporción de dehiscencias anastomóticas clínicas y subclínicas, la proporción de estenosis anastomóticas, el tiempo demandado para la confección de la sutura y la cantidad de paquetes de hilo utilizados. Resultados: Se observó 1 dehiscencia anastomótica, 1 dehiscencia subclínica y 1 estenosis en el grupo 1, 2 dehiscencias subclínicas en el grupo II, y 1 dehiscencia subclínica en el grupo m. En el grupo II se utilizaron 4,46 paquetes de sutura y se emplearon 18,5 minutos para confeccionar la sutura, mientras que en el grupo se requirieron 2,06 paquetes de hilo y se tardó 14,4 minutos. Conclusiones: El análisis estadístico mostró que las anastomosis intestinales intraperitoneales pueden realizarse con materiales sintéticos reabsorbibles sin incrementar los riesgos de complicaciones, y que las suturas continuas permiten obtener resultados similares a aquellas efectuadas mediante puntos separados, contando con la ventaja de requerir menor tiempo para su confección, y menor cantidad de hilos de sutura. (AU)

Suturas colónicas: variantes técnicas y resultados / Results and variety on colonic anastomosis

Antecedentes: Desde los comienzos de la cirugía moderna se ha investigado en la búsqueda de la técnica de sutura ideal para efectuar anastomosis intestinales. Objetivos: Demostrar que: 1) Las suturas continuas en las anastomosis intestinales tienen idéntico resultado que las suturas a puntos separados, son más rápidas y económicas. 2) Los materiales sintéticos reabsorbibles permiten obtener resultados similares a los alcanzados con material irreabsorbible como el lino quirúrgico. Diseño: Comparativo, prospectivo, transversal y experimental. Población y muestra: Se incluyeron todas las anastomosis íleo-colónicas, colocolónicas, ileorectales y colorectales intraperitoneales por cualquier patología, programadas o de urgencia. Se compararon 3 técnicas anastomóticas: Puntos separados de lino en el grupo I, que incluyó 18 casos; Puntos separados de material sintético reabsorbible en el grupo II, que incluyó 19 pacientes; Sutura continua de material sintético reabsorbible en el grupo M, que también se integró con 19 enfermos. Material y método: Se analizaron la proporción de dehiscencias anastomóticas clínicas y subclínicas, la proporción de estenosis anastomóticas, el tiempo demandado para la confección de la sutura y la cantidad de paquetes de hilo utilizados. Resultados: Se observó 1 dehiscencia anastomótica, 1 dehiscencia subclínica y 1 estenosis en el grupo 1, 2 dehiscencias subclínicas en el grupo II, y 1 dehiscencia subclínica en el grupo m. En el grupo II se utilizaron 4,46 paquetes de sutura y se emplearon 18,5 minutos para confeccionar la sutura, mientras que en el grupo se requirieron 2,06 paquetes de hilo y se tardó 14,4 minutos. Conclusiones: El análisis estadístico mostró que las anastomosis intestinales intraperitoneales pueden realizarse con materiales sintéticos reabsorbibles sin incrementar los riesgos de complicaciones, y que las suturas continuas permiten obtener resultados similares a aquellas efectuadas mediante puntos separados, contando con la ventaja de requerir menor tiempo para su confección, y menor cantidad de hilos de sutura.

Comparison of skin stapling devices and standard sutures for pediatric scalp lacerations: a randomized study of cost and time benefits.

OBJECTIVE: To compare the total costs and the physician time requirements for suture and staple repair of pediatric scalp lacerations. STUDY DESIGN: Eighty-eight children, 13 months to 16 years of age, coming to a children's hospital emergency department with simple scalp lacerations were prospectively randomly selected to receive staple or suture repair. Wound lengths, times required for initial wound care and closure, and equipment use were recorded. Patients returned in 1 week for suture or staple removal and wound reevaluation. The two methods were compared in terms of both time expended and costs of equipment and physician compensation. RESULTS: Forty-five children underwent staple repair and 43 underwent suture repair. There were no differences in age, sex, wound length, number of sutures or staples per centimeter, or physician experience. Stapling resulted in shorter wound closure times (65 vs 397 seconds; p < 0.0001) and shorter overall times for wound care and closure (395 vs 752 seconds; p < 0.0001). Staple repair was less expensive in terms of equipment ($12.55 vs $17.59; p < 0.0001) and total cost based on equipment and physician time ($23.55 vs $38.51; p < 0.0001). The follow-up rate was 91%, with no cosmetic or infectious complications in either group. CONCLUSIONS: Stapling is faster and less expensive than suturing in the repair of uncomplicated pediatric scalp lacerations, with no additional complications. Physicians who treat children with scalp lacerations should consider the use of stapling devices.

Prospective study using skin staplers in head and neck surgery.

BACKGROUND: A prospective trial was undertaken to investigate the advantages and disadvantages of stapled skin closure versus conventional nylon sutures in head and neck surgery. PATIENTS AND METHODS: The study included 20 consecutive patients who underwent extensive surgery in which their skin was closed with staples. Another group of 20 matched patients receiving a noncontinuous nylon suture closure was followed in parallel. RESULTS: The complications recorded occurred in 5 patients in the stapled group and 3 in the sutured group. Analysis of cosmetic results showed 16 patients (80%) in the stapled group with good wound appearance and 17 (85%) in the sutured group. The mean closure time was 5 minutes for the stapled group and 25 minutes for the sutured group. Cost was $19.75 for conventional closure and $22.00 for mechanical suture. CONCLUSION: The use of skin staples speeds up closure time by 80%, yields similar cosmetic results with no increase in complications, although at a slightly higher cost.

Economic comparison of a tissue adhesive and suturing in the repair of pediatric facial lacerations.

OBJECTIVE: To determine, from the societal perspective, the most cost efficient of the three methods commonly used to repair pediatric facial lacerations: nondissolving sutures, dissolving sutures, or a tissue adhesive (Histoacryl blue). DESIGN: Cost-minimization analysis and willingness-to-pay survey. SETTING: Tertiary-care pediatric emergency department. METHODS: All differential costs relevant to equipment utilization, pharmaceutical use, health care worker time, and parental loss of income for follow-up visits were calculated for each method. On the basis of previous research, our model assumes equal cosmetic outcome for the three methods. In addition, a convenience sample of 30 parents were surveyed in the emergency department to rank their preferences and willingness to pay for the three methods of wound closure. RESULTS: The reduction in cost (in Canadian dollars) per patient of switching from the standard nondissolving sutures was $49.60 for switching to tissue adhesive and $37.90 for dissolving sutures. Sensitivity analyses performed on key variables did not significantly alter our conclusions. Of those parents surveyed; 90% (95% confidence interval, 74% to 98%) chose tissue adhesive and 10% (95% confidence interval, 2% to 26%) chose dissolving sutures as their first choice for wound closure. Nondissolving sutures were ranked third by 29 of 30 parents. Parents were willing to pay a median (25th to 75th percentile) of $40 ($25 to $100) for tissue adhesive and $25 ($10 to $56) for dissolving sutures if only nondissolving sutures provided by the health care system (p = 0.1). CONCLUSIONS: Tissue adhesive is the preferred method of closure of pediatric facial lacerations because it results in the most efficient use of resources and is preferred by the majority of parents.

Comparison of hemp and cotton fiber implants in muscle rat tissue. Study of the inflammatory response.

Hemp fiber is obtained from the plant Musa textilis. The cost of preparation of its raw fibers is low. The purpose of this paper was to compare the inflammatory response in the rat muscle tissue originated by both hemp and cotton fibers. Both types of fibers, were implanted in gluteal muscles of Sprague Dawley rats. The rats were sacrificed at 15, 30 and 60 postoperative days. Muscle tissue sections were stained with hematoxilyneosin. The inflammatory response was measured by subtracting the suture surface area from the total granulomatous area. At 15 days, the inflammatory response was more conspicuous for hemp than for cotton fiber (P < 0.05). At 30 and 60 days, responses were similar (P > 0.05). We cannot conclude that the hemp fiber is superior to cotton, nevertheless, they behave the same. Therefore, hemp constitutes an alternative as suture material.