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1.
BMC Surg ; 21(1): 47, 2021 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-33478457

RESUMO

BACKGROUND: Recently, due to increasing reports of stenosis after esophagojejunostomy created using circular staplers and a transorally inserted anvil (OrVil™) following laparoscopic proximal gastrectomy (LPG) and total gastrectomy (LTG), linear staplers are being used instead. We investigated our preventive procedure for esophagojejunostomy stenosis following use of circular staplers. METHODS: Since the anastomotic stenosis is considered to be mainly caused by tension in the esophageal and jejunal stumps at the anastomotic site, we have been performing procedures to relieve this tension, by cutting off the rubber band and pushing the shaft of the circular stapler toward the esophageal side, since July 2015. We retrospectively compared the incidence of anastomotic stenosis in cases of LPG and LTG performed before July 2015 (early phase, 30 cases) versus those performed after this period (later phase, 22 cases). RESULTS: Comparison of the incidence of anastomotic stenosis according to the type of surgery, LPG or LTG, and between the two time periods versus all cases, indicated a significantly lower incidence in the later phase than in the early phase (4.5 vs. 26.7%, p < 0.05), especially for LPG (0 vs. 38.5%, p < 0.05). CONCLUSIONS: It is possible to use a circular stapler during laparoscopic esophagojejunostomy, as with open surgery, if steps to reduce tension on the anastomotic site are undertaken. These procedures will contribute to the spread of safe and simple laparoscopic anastomotic techniques.


Assuntos
Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Constrição Patológica/prevenção & controle , Esôfago/cirurgia , Jejuno/cirurgia , Neoplasias Gástricas , Idoso , Anastomose Cirúrgica/instrumentação , Constrição Patológica/etiologia , Feminino , Gastrectomia/efeitos adversos , Gastrectomia/métodos , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias Gástricas/cirurgia , Grampeamento Cirúrgico/instrumentação , Grampeamento Cirúrgico/métodos
2.
Zhonghua Wei Chang Wai Ke Za Zhi ; 24(1): 35-42, 2021 Jan 25.
Artigo em Chinês | MEDLINE | ID: mdl-33461250

RESUMO

In the past 30 years, minimally invasive surgery has been greatly improved with the development of the energy platform, instrument platform, and imaging platform. Taking colorectal cancer surgery as an example, the five elements of surgical procedure have developed to a certain extent. The surgical approach has undergone a process from large to small. The range of resection ranges from simple bowel resection to radical resection/extended radical resection, and then to surgery that focuses on preserving organ function. With the recognition of the direction of normal lymphatic drainage and the characteristics of tumor lymphatic metastasis, lymph node dissection has been gradually standardized. The reconstruction of the digestive tract has changed from manual sutures to full endoscopic anastomosis, and then to the concept of functional anastomosis. The removal of the specimen has improved from large incision through the abdominal wall, to small laparoscopic incision, and then to the natural cavity. The evolution of these procedures depends on the advancement of technology platforms and equipment, and the recognition of new concepts. The development of minimally invasive platform must be in the direction of ensuring the implementation of the most optimized surgical approach. The platform is more secure, integrated, multifunctional, and intelligent. In the future, minimally invasive procedures must be aimed at maximizing the benefits of patients. The procedures are more scientific, functional, comfortable and diverse. Surgical innovation has promoted the development of the platform. The platform and the surgical procedure promote each other's development.


Assuntos
Neoplasias Colorretais/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório , Laparoscopia , Procedimentos Cirúrgicos Minimamente Invasivos/tendências , Anastomose Cirúrgica/instrumentação , Anastomose Cirúrgica/métodos , Anastomose Cirúrgica/tendências , Neoplasias Colorretais/patologia , Procedimentos Cirúrgicos do Sistema Digestório/instrumentação , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Procedimentos Cirúrgicos do Sistema Digestório/tendências , Previsões , Humanos , Laparoscopia/instrumentação , Laparoscopia/métodos , Laparoscopia/tendências , Excisão de Linfonodo , Metástase Linfática , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Técnicas de Sutura/instrumentação , Técnicas de Sutura/tendências
4.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(6): 602-605, 2020 Jun 25.
Artigo em Chinês | MEDLINE | ID: mdl-32521983

RESUMO

Objective: To observe preventive effect of intestinal stent against anastomotic leakage after rectal cancer operation. Methods: A retrospective cohort study was carried out. Clinical data of 107 patients with low rectal cancer undergoing laparoscopic radical resection from January 2015 to August 2019 were retrospectively analyzed. Intestinal stent was placed intraoperatively in 48 cases and was not placed in 59 cases. Postoperative Wexner score for anal function and incidence of anastomotic leakage were compared between patients with and without intstinal stent. Results: There was no significant differences in age, distance between tumor and the anal verge, operative time and postoperative Wexner score for anal function between the two groups (all P>0.05). After a month of follow-up, the incidence of anastomotic leakage was 16.9% (10/59) in the non-stent group, while no anastomotic leakage was found in the stent group (P=0.002). Conclusion: Placement of intestinal stent can effectively prevent anastomotic leakage after low rectal cancer surgery.


Assuntos
Anastomose Cirúrgica/métodos , Fístula Anastomótica/prevenção & controle , Protectomia/efeitos adversos , Neoplasias Retais/cirurgia , Reto/cirurgia , Stents , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/instrumentação , Fístula Anastomótica/etiologia , Humanos , Protectomia/métodos , Implantação de Prótese , Estudos Retrospectivos , Fatores de Risco
6.
Artigo em Inglês | MEDLINE | ID: mdl-32459078

RESUMO

Right ventricle to pulmonary artery conduits such as homografts and pre-manufactured synthetic conduits are widely employed in the present era of complex congenital cardiac surgeries for disorders involving right ventricle - pulmonary artery discontinuity and major coronary artery crossing the right ventricular outflow tract. The key drawback of homograft conduits is the need for reoperation to replace them as a result of degeneration over time or in cases where a child has outgrown the conduit and cost is a major drawback to using commercially available conduits. The advantages of expanded polytetrafluoroethylene are its long-term durability in terms of conduit calcification/degeneration and valve stenosis/regurgitation and its cost-effectiveness.  In this video presentation, we demonstrate the preparation and intraoperative usage of a handmade, trileaflet, valved polytetrafluoroethylene conduit in a case of double outlet right ventricle with valvular and subvalvular pulmonary stenosis and the left anterior descending artery crossing the right ventricular outflow tract. Our experience with this handmade conduit is close to 120 cases and we have seen excellent postoperative recovery and results. Our medium-term follow-up echocardiographic evidence shows conduit patency and preserved valve function.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Dupla Via de Saída do Ventrículo Direito/cirurgia , Ventrículos do Coração/cirurgia , Desenho de Prótese/métodos , Artéria Pulmonar/cirurgia , Anastomose Cirúrgica/instrumentação , Anastomose Cirúrgica/métodos , Materiais Biocompatíveis/uso terapêutico , Procedimentos Cirúrgicos Cardíacos/instrumentação , Procedimentos Cirúrgicos Cardíacos/métodos , Cateteres , Criança , Humanos , Masculino , Politetrafluoretileno/uso terapêutico , Implantação de Prótese/métodos , Reoperação/instrumentação , Reoperação/métodos , Resultado do Tratamento
8.
Medicine (Baltimore) ; 99(10): e19474, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32150110

RESUMO

The modified Blumgart method for pancreaticojejunostomy has been shown to reduce the rate of postoperative pancreatic fistula (POPF) in open surgery. We describe a modified Blumgart method using LAPRA-TY suture clips to facilitate laparoscopic pancreaticojejunostomy.We prepared a double-armed 4-0 nonabsorbable monofilament, which was ligated using the LAPRA-TY clip at the tail end, 12-cm in length. Next, the U-suture was placed through the pancreatic stump and the seromuscular layer of the jejunum. We performed duct-to-mucosa suturing with a 5-0 absorbable monofilament. After completing the duct-to-mucosa suturing, as a final step we placed the sutures through the seromuscular layer of the jejunum on the ventral side and tightly secured the thread with the LAPRA-TY clips. We performed laparoscopic Blumgart pancreaticojejunostomy during pancreaticoduodenectomy in 39 patients. We compared the surgical outcomes of 19 patients who underwent Blumgart pancreaticojejunostomy using the LAPRA-TY clips (LAPRA-TY group) with 20 patients undergoing surgery not using the LAPRA-TY clips (conventional group).The rate of clinically relevant postoperative pancreatic fistula in the LAPRA-TY group was 21.1%, which did not differ significantly from the rate of the conventional group. However, the mean time of pancreaticojejunostomy in the LAPRA-TY group was 56.2 min (range, 39-79 min), which was significantly shorter than that of the conventional group (69.7 min; range, 53-105 min, P < .001).Although the modified Blumgart pancreaticojejunostomy using LAPRA-TY suture clips did not improve the pancreatic fistula rate, it allowed for shorter operative times. Thus, this procedure lends itself to positive surgical and patient outcomes.


Assuntos
Anastomose Cirúrgica/instrumentação , Laparoscopia/instrumentação , Fístula Pancreática/cirurgia , Pancreaticojejunostomia/instrumentação , Instrumentos Cirúrgicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pancreaticoduodenectomia , Complicações Pós-Operatórias , Técnicas de Sutura , Resultado do Tratamento
9.
Sci Rep ; 10(1): 1518, 2020 01 30.
Artigo em Inglês | MEDLINE | ID: mdl-32001759

RESUMO

Stricture of pancreatic-enteric anastomoses is a major late complication of a pancreaticoduodenectomy for the treatment of a periampullary tumor and can lead to exocrine and endocrine insufficiency such as malnutrition and diabetes mellitus. We investigated the safety and efficacy of a biodegradable tubular stent (BTS) for preventing a pancreaticojejunostomy (PJ) anastomotic stricture in both a rat and porcine model. The BTS was manufactured using a terpolymer comprising poly p-dioxanone, trimethylene carbonate, and glycolide. A cohort of 42 rats was randomized into 7 groups of 6 animals each after BTS placement into the duodenum for the biodegradation assay. A total of 12 pigs were randomized equally into a control and BTS placement group. The effectiveness of the BTS was assessed by comparing radiologic images with histologic results. Surgical procedures and/or BTS placements were technically successful in all animals. The median mass losses of the removed BTS samples from the rat duodenum were 2.1, 6.8, 11.2, 19.4, 26.1, and 56.8% at 1, 2, 3, 4, 6, and 8 weeks, respectively. The BTS had completely degraded at 12 weeks in the rats. In the porcine PJ model, the mean luminal diameter and area of the pancreatic duct in the control group was significantly larger than in the BTS group (all p < 0.05). BTS placement thus appears to be safe and effective procedure for the prevention of PJ anastomotic stricture. These devices have the potential to be used as a temporary stent placement to treat pancreatic-enteric anastomoses, but further investigations are required for optimization in human.


Assuntos
Implantes Absorvíveis/veterinária , Anastomose Cirúrgica/instrumentação , Anastomose Cirúrgica/métodos , Animais , Constrição Patológica/cirurgia , Modelos Animais de Doenças , Masculino , Pâncreas/cirurgia , Ductos Pancreáticos/cirurgia , Pancreaticoduodenectomia/efeitos adversos , Pancreaticoduodenectomia/métodos , Pancreaticojejunostomia , Complicações Pós-Operatórias/cirurgia , Ratos , Ratos Sprague-Dawley , Stents , Suínos
10.
J Pediatr Surg ; 55(5): 821-823, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32061365

RESUMO

BACKGROUND/PURPOSE: Magnamosis is a novel technique which utilizes high power magnets to anastomose the esophageal ends in children with esophageal atresia (EA) with or without a tracheoesophageal fistula (TEF), theoretically avoiding the need for thoracotomy. The objective of this study was to compare anastomotic stricture formation requiring dilatation after magnamosis versus after conventional anastomosis. METHODS: Our center treated the first 3 cases of EA ±â€¯TEF with magnamosis in Canada. One was unsuccessful and excluded from our study. The number of postintervention dilatations was compared to controls from our database, which includes all children with EA ±â€¯TEF treated between 1991 and 2015. The controls had EA ±â€¯TEF treated with pouch-to-end anastomosis or colonic interposition (n = 65). Mann-Whitney U tests were used with p < 0.05 being significant. RESULTS: The 2 magnamosis cases had a mean of 13.5 dilatations, compared to 2.6 for the controls. Those managed with pouch-to-end anastomosis or colonic interposition had a mean of 2.3 and 2.7 dilatations, respectively. We found that the cases required more dilatations than controls (p = 0.022) and pouch-to-end anastomosis (p = 0.021), but not than colonic interposition (p = 0.106). CONCLUSION: Our results indicate that magnamosis is associated with more postintervention dilatations than conventional anastomotic techniques, suggesting that magnamosis results in more frequent and/or more resilient anastomotic strictures. LEVEL OF EVIDENCE: 3.


Assuntos
Anastomose Cirúrgica , Atresia Esofágica/cirurgia , Imãs , Fístula Traqueoesofágica/cirurgia , Anastomose Cirúrgica/instrumentação , Anastomose Cirúrgica/métodos , Canadá , Criança , Dilatação , Humanos
12.
Acta Neurochir (Wien) ; 162(1): 175-179, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31748901

RESUMO

BACKGROUND: The excimer laser-assisted non-occlusive anastomosis (ELANA) technique facilitates the construction of anastomoses without temporary occlusion of the recipient artery. Experiments aimed at simplifying the technique eventually resulted in a sutureless ELANA slide (SEsl) anastomosis. After the first clinical use, new insights lead to the application of a clip at the back of the device, the SELANA clip (SEcl). The SEcl offers a distinct advantage over the SEsl since no sealant is necessary. In this study, we determine the feasibility of the SEcl anastomosis in an in vivo rabbit model. METHODS: 15 SEcl anastomoses and 15 conventional ELANA anastomoses were created on the abdominal aorta in 5 rabbits. Mean application times, flap retrieval rates, hemostasis, and burst pressures were assessed. RESULTS: The mean application time of the SEcl anastomoses was 11.4 min versus 39.0 min for the ELANA anastomoses (mean difference, 27.6 min; 95% CI, 20.6-34.7). The flap retrieval rate of the SEcl anastomoses (14/15) was not inferior to the flap retrieval rate of the ELANA anastomoses (13/15). Direct hemostasis was achieved in 13/15 (87%) SEcl anastomoses and in 14/15 (94%) ELANA anastomoses. All SEcl anastomoses were resistant to provoked pressures until 250 mmHg. CONCLUSION: The SEcl anastomosis is technically feasible in in vivo experiments. Mean application time, flap retrieval rate, hemostasis, and burst pressure are not inferior to the conventional ELANA anastomosis. Further long term experiments should be performed to assess safety, patency, and reendothelialization.


Assuntos
Anastomose Cirúrgica/métodos , Revascularização Cerebral/métodos , Lasers de Excimer/efeitos adversos , Instrumentos Cirúrgicos/efeitos adversos , Anastomose Cirúrgica/instrumentação , Animais , Aorta Abdominal/cirurgia , Revascularização Cerebral/instrumentação , Estudos de Viabilidade , Lasers de Excimer/normas , Coelhos , Retalhos Cirúrgicos/cirurgia , Instrumentos Cirúrgicos/normas
13.
Plast Reconstr Surg ; 145(1): 235-240, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31609285

RESUMO

BACKGROUND: Although the surgical microscope remains the most common tool used for visual magnification for microsurgical anastomoses in free tissue transfer, loupe-only magnification for free flap breast reconstruction has been demonstrated to be safe and effective. To evaluate the loupe-only technique in lower extremity free flap reconstruction, the authors compared perioperative outcomes between microsurgical anastomoses performed with loupe magnification versus a surgical microscope. METHODS: The authors conducted a two-institution retrospective study of soft-tissue free flaps for traumatic below-knee reconstruction. Optimal subgroup matching was performed using patient age, defect location, flap type (muscle versus fasciocutaneous), and time from injury (acute, <30 days; remote, >30 days) for conditional logistic regression analysis of perioperative outcomes. RESULTS: A total of 373 flaps met inclusion criteria for direct matched comparison of anastomoses performed with loupe magnification (n = 150) versus a surgical microscope (n = 223). Overall major complication rates were 15.3 percent: take-back for vascular compromise, 7.8 percent; partial flap failure, 7.8 percent; and total flap loss, 5.4 percent. No differences were observed between the loupe and microscope groups regarding major complications (14.0 percent versus 16.1 percent; OR, 0.78; 95 percent CI, 0.38 to 1.59), take-back for vascular compromise (5.3 percent versus 9.4 percent; OR, 0.51; 95 percent CI, 0.19 to 1.39), any flap failure (13.3 percent versus 13.0 percent; OR, 1.21; 95 percent CI, 0.56 to 2.64), partial flap failure (7.3 percent versus 8.1 percent; OR, 1.04; 95 percent CI, 0.43 to 2.54), and total flap loss (6.0 percent versus 4.9 percent; OR, 1.63; 95 percent CI, 0.42 to 6.35). CONCLUSIONS: Perioperative complication rates, take-backs for vascular compromise, partial flap losses, and total flap failure rates were not significantly different between the matched loupe and microscope groups. Overall microsurgical success rates in traumatic lower extremity free flap reconstruction appear to be independent of the microsurgical technique used for visual magnification. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Retalhos de Tecido Biológico/transplante , Extremidade Inferior/lesões , Microcirurgia/instrumentação , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/instrumentação , Anastomose Cirúrgica/métodos , Criança , Pré-Escolar , Feminino , Retalhos de Tecido Biológico/efeitos adversos , Retalhos de Tecido Biológico/irrigação sanguínea , Rejeição de Enxerto/epidemiologia , Rejeição de Enxerto/etiologia , Humanos , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/cirurgia , Masculino , Microcirurgia/efeitos adversos , Microcirurgia/métodos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
15.
Ann R Coll Surg Engl ; 102(2): 153-159, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31508982

RESUMO

INTRODUCTION: Anastomosis formation constitutes a critical aspect of many gastrointestinal procedures. Barbed suture materials have been adopted by some surgeons to assist in this task. This systematic review and meta-analysis compares the safety and efficacy of barbed suture material for anastomosis formation compared with standard suture materials. METHODS: An electronic search of Embase, Medline, Web of Science and Cochrane databases was performed. Weighted mean differences were calculated for effect size of barbed suture material compared with standard material on continuous variables and pooled odds ratios were calculated for discrete variables. FINDINGS: There were nine studies included. Barbed suture material was associated with a significant reduction in overall operative time (WMD: -12.87 (95% CI = -20.16 to -5.58) (P = 0.0005)) and anastomosis time (WMD: -4.28 (95% CI = -6.80 to -1.75) (P = 0.0009)). There was no difference in rates of anastomotic leak (POR: 1.24 (95% CI = 0.89 to 1.71) (P = 0.19)), anastomotic bleeding (POR: 0.80 (95% CI = 0.29 to 2.16) (P = 0.41)), or anastomotic stricture (POR: 0.72 (95% CI = 0.21 to 2.41) (P = 0.59)). CONCLUSIONS: Use of barbed sutures for gastrointestinal anastomosis appears to be associated with shorter overall operative times. There was no difference in rates of complications (including anastomotic leak, bleeding or stricture) compared with standard suture materials.


Assuntos
Anastomose Cirúrgica/instrumentação , Procedimentos Cirúrgicos do Sistema Digestório/instrumentação , Suturas , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Fístula Anastomótica/etiologia , Constrição Patológica/etiologia , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Desenho de Equipamento , Humanos , Duração da Cirurgia , Complicações Pós-Operatórias , Hemorragia Pós-Operatória/etiologia , Técnicas de Sutura/instrumentação
16.
J Plast Surg Hand Surg ; 54(1): 19-23, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31448658

RESUMO

Microvascular anastomosis is mandatory for free flap surgery, but free flap transfer can be challenging because of vascular diameter discrepancies during microsurgery. Different methods have been described for preventing vascular discrepancies. The aim of this study was to test a simple technique using a hemostatic clip to taper the vessels. In 12 patients who had free tissue transfer with diameter discrepancies between donor and recipient vessels, tapering with a hemostatic clip technique was used. After key sutures were placed on the vessels, a hemostatic clip was placed in an oblique fashion on the vessel with a larger diameter. After the vessel was tapered and the same diameters in the donor and recipient vessels were achieved, anastomosis was completed. This technique was used in head and neck reconstruction and lower extremity reconstruction. The luminal diameters of arteries, and veins of the flap and recipient differed by 1.6- to 3.0-fold and 1.5- to 2.6-fold, respectively. All the flaps survived without complications. Tapering with a hemoclip technique is a rapid procedure that can be considered for managing vascular diameter discrepancies in free tissue transfers.


Assuntos
Anastomose Cirúrgica/instrumentação , Anastomose Cirúrgica/métodos , Retalhos de Tecido Biológico/irrigação sanguínea , Técnicas Hemostáticas/instrumentação , Microcirurgia/métodos , Adulto , Feminino , Sobrevivência de Enxerto , Humanos , Masculino , Pessoa de Meia-Idade
17.
J Pediatr Surg ; 55(3): 425-432, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31128845

RESUMO

INTRODUCTION: Fashioning a patent, watertight anastomosis in patients with esophageal atresia is a challenging task in pediatric surgery, particularly when performed under tension. A reproducible suture-less alternative would decrease operative time. We evaluated magnetic esophageal compression anastomoses in a novel bypass-loop swine model. METHODS: Eight-week-old piglets underwent thoracotomy to mobilize the esophagus at the carina to create a U-shaped loop. Custom-made 8 mm diameter Neodymium Magnets were inserted into the esophagus proximal and distal to the loop, then mated side-to-side at the future anastomosis site. Pigs were observed for 8 (n = 4), 10 (n = 6), and 12 (n = 2) days and then sacrificed. The magnetic compression anastomosis was evaluated macroscopically, by radiography, burst pressure testing, and histology. RESULTS: All 12 pigs survived until the endpoint. Separation of the magnets occurred at a median of 9 days. Contrast esophagrams showed patency and no leak. All anastomoses withstood pressures well over 13 kPa without leak. Histopathology showed epithelialized circular scar tissue. CONCLUSION: Magnetic compression anastomoses of the esophagus using our specially-designed magnets are formed between the 8th and 10th postoperative day, are patent and mechanically resistant to supraphysiologic intraluminal pressures. These data lay the basis for a potential clinical application in patients born with esophageal atresia. LEVEL OF EVIDENCE: Not applicable (experimental animal study).


Assuntos
Anastomose Cirúrgica , Atresia Esofágica/cirurgia , Imãs , Anastomose Cirúrgica/instrumentação , Anastomose Cirúrgica/métodos , Animais , Modelos Animais de Doenças , Esôfago/cirurgia , Feminino , Gravidez , Suínos
18.
Int J Surg ; 72: 80-84, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31683041

RESUMO

OBJECTIVE: Proper techniques used in procedures might play an important role in reducing ureteroileal anastomosis stricture (UIAS) for patients undergoing orthotopic neobladder. The present study was to evaluate the efficacy of internal double-J stent versus external ureteral catheter on UIAS for patients undergoing radical cystectomy and orthotopic neobladder. METHODS: A comprehensive search of the literature referring to the topic was performed on 10th January 2019 in PubMed, EMBASE and Google Scholar, by using key words as radical cystectomy, orthotopic neobladder, stricture, stenosis. The Cochrane Collaboration's RevMan 5.3 software was employed for data analysis. The incidence of UIAS was evaluated as primary outcome. RESULTS: Five studies were included eventually. The incidence of UIAS was lower in the group of internal double-J stent than that in the group of external ureteral catheter (odds ratio [OR], 0.49; 95% CI, 0.25-0.97; p = 0.04) with a low heterogeneity (I2 = 0%). Besides, internal double-J stent group had a trend of a shorter length of stay than external ureteral catheter group. CONCLUSIONS: Based on the present meta-analysis, internal double-J stent placement was associated with a lower incidence of UIAS than external ureteral catheter for patients undergoing orthotopic neobladder. In addition, a trend of a shorter hospital stay was also detected, thus, internal double-J stent placement may be favored in the view of the enhanced recovery after surgery (ERAS).


Assuntos
Cistectomia/instrumentação , Stents/efeitos adversos , Obstrução Ureteral/etiologia , Derivação Urinária/instrumentação , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/instrumentação , Anastomose Cirúrgica/métodos , Constrição Patológica/etiologia , Cistectomia/métodos , Humanos , Íleo/cirurgia , Incidência , Complicações Pós-Operatórias/etiologia , Ureter/cirurgia , Neoplasias da Bexiga Urinária/cirurgia , Cateteres Urinários/efeitos adversos , Derivação Urinária/efeitos adversos , Derivação Urinária/métodos
19.
Arq Bras Cir Dig ; 32(3): e1452, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31644672

RESUMO

BACKGROUND: In high-income countries, morbid obesity is a growing health problem that has already reached epidemic proportions. When performing a laparoscopic gastric bypass several operative methods exist. AIM: To describe the institutional experience using a knotless unidirectional barbed suture (V-Loc 180/Covidien, Mansfield, MA) to create a hand-sewn gastrojejunostomy (GJ) and jejunojejunostomy (JJ) during bariatric surgery. METHODS: Evaluation of a case series of 87 morbidly obese patients who underwent laparoscopic gastric bypass with a hand-sewn gastrojejunostomy (GJA) and jejunojejunostomy (JJA) between 01/2015 and 06/2017. The patients were divided into two groups: in group I, GJA und JJA sutures were performed using the knotless unidirectional barbed suture; in group II, GJA and JJA were sutured with resorbable multifilament thread (Vicryl® 3/0 Ethicon, Livingstone, UK). The recorded data on gender, age, BMI, ASA score, operative time, postoperative morbidity, length of hospital stay, and reoperation, were analyzed and compared. RESULTS: All procedures were completed laparoscopically with no mortality. The mean operative time was 123.23 (±30.631) in group I and 127.57 (±42.772) in group II (p<0.05). The postoperative complications did not differ significantly between the two groups. Early complications were observed for two patients (0.9%) in the barbed suture group and for one patient (0.42%) in the multifilament suture group (p<0.05). In group I two patients (0.9%) required reoperation: on the basis of jejunojejunal stenosis in one patient, and local abscess near the gastrojejunostomy, without a leakage, in the other. In group II one patient (0.42%) required reoperation due to stenosis of the GJA. The duration of hospital admission was similar for both groups: 3.36 (±0.743) days in group I vs. 3.38 (±1.058) days in group II (p<0.05). CONCLUSION: The novel anastomotic technique is a safe and effective method and can be applied to gastrojejunal anastomosis and jejunojejunal anastomosis in laparoscopic gastric bypass.


Assuntos
Cirurgia Bariátrica/instrumentação , Segurança de Equipamentos/instrumentação , Obesidade Mórbida/cirurgia , Técnicas de Sutura/instrumentação , Adulto , Anastomose Cirúrgica/instrumentação , Anastomose Cirúrgica/métodos , Cirurgia Bariátrica/métodos , Feminino , Derivação Gástrica/instrumentação , Derivação Gástrica/métodos , Humanos , Jejunostomia/instrumentação , Jejunostomia/métodos , Jejuno/cirurgia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Poliglactina 910 , Complicações Pós-Operatórias , Estudos Prospectivos , Estômago/cirurgia , Resultado do Tratamento , Técnicas de Fechamento de Ferimentos/instrumentação
20.
Acta Cir Bras ; 34(7): e201900709, 2019 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-31531529

RESUMO

PURPOSE: To develop a new low-cost, easy-to-make and available training model using chickens' intestine for infant intestinal anastomosis. METHODS: Segments of chicken intestine were used to create an intestinal anastomosis simulator. We tried to perform an end-to-end, end-to-side and side-to-side anastomosis. Handsewn sutured anastomosis were performed in single layered with interrupted prolene 5-0 suture. The parameters analyzed were cost, intestine's diameter and length, anastomosis patency and flow-through and leakage amount. RESULTS: In all cases it was possible to make the anastomosis in double layered without difficulties, different from the usual ones. There was a positive patency at all anastomoses after the end of the procedure, with no need for reinterventions. CONCLUSION: The new training model using chickens' intestine for infant intestinal anastomosis is low-cost, easy-to-make and easy available.


Assuntos
Anastomose Cirúrgica/educação , Intestinos/cirurgia , Pediatria/educação , Anastomose Cirúrgica/instrumentação , Anastomose Cirúrgica/métodos , Animais , Galinhas , Criança , Humanos , Modelos Animais , Técnicas de Sutura
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