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1.
J Surg Res ; 246: 427-434, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31699537

RESUMO

BACKGROUND: The use of a small circular stapler (CS) has been reported to increase the incidence of benign anastomotic stricture of the intrathoracic anastomosis after esophagectomy, but no study has evaluated the effects of the CS size on cervical esophagogastrostomy. Based on a propensity-matched comparison, the present study was designed to determine whether the perioperative outcomes differ between 21- and 25-mm CSs after minimally invasive esophagectomy with cervical anastomosis. METHODS: From January 2015 to December 2017, 162 patients who received CS cervical esophagogastric anastomosis after minimally invasive esophagectomy for esophageal cancer were identified from our surgical database. A propensity-matched analysis was used to compare the outcomes between the 21- and 25-mm CS groups. Endpoints included anastomotic leak, dysphagia, reflux, stricture, and other major postoperative outcomes within 6 postoperative months. RESULTS: There were 69 and 93 patients in the 21- and 25-mm CS groups, respectively. Propensity matching produced 57 patients in each group. The two groups were not remarkably different in benign anastomotic stricture rate (P = 0.528). All strictures were resolved by balloon dilatation. The 25-mm CS group had a significantly longer operative time in cervical anastomosis than the 21-mm group (P = 0.005). No statistically significant differences in anastomotic leak rates, dysphagia scores, reflux scores, or other postoperative complications were noted between the two groups. CONCLUSIONS: The use of a 21-mm CS in minimally invasive esophagectomy with cervical esophagogastric anastomosis did not result in greater anastomotic stricture as compared with a 25-mm CS. The 21-mm CS was associated with a significantly shorter operative time.


Assuntos
Fístula Anastomótica/epidemiologia , Neoplasias Esofágicas/cirurgia , Esofagectomia/efeitos adversos , Refluxo Gastroesofágico/epidemiologia , Grampeadores Cirúrgicos/efeitos adversos , Idoso , Anastomose Cirúrgica/efeitos adversos , Fístula Anastomótica/etiologia , Constrição Patológica/epidemiologia , Constrição Patológica/etiologia , Esofagectomia/instrumentação , Esofagectomia/métodos , Esofagostomia/efeitos adversos , Esofagostomia/instrumentação , Esofagostomia/métodos , Feminino , Refluxo Gastroesofágico/etiologia , Gastrostomia/efeitos adversos , Gastrostomia/instrumentação , Gastrostomia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Pontuação de Propensão , Estudos Retrospectivos , Grampeamento Cirúrgico/efeitos adversos , Grampeamento Cirúrgico/instrumentação , Grampeamento Cirúrgico/métodos , Fatores de Tempo , Resultado do Tratamento
2.
Anticancer Res ; 39(12): 6799-6806, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31810945

RESUMO

BACKGROUND/AIM: In order to overcome postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP), we have developed a new simple technique-Clip on Staple method. PATIENTS AND METHODS: In Clip on Staple method, pancreatic parenchyma was divided using a stapling device with a stepped-height staple design to make linear compression line, and thereafter, the full length of the staple line was reinforced by multiple clips. Clinical outcomes were retrospectively compared between Clip on Staple group (n=23) and Non-Clip group (n=38). RESULTS: The incidence of clinically relevant POPF (CR-POPF) was significantly lower in the Clip on Staple group than in the Non-Clip group (4.3 and 36.8%, p=0.005). Multivariate logistic regression analysis revealed that only Clip on Staple method was an independent predictive factor of a decrease in the occurrence of CR-POPF. CONCLUSION: The Clip on Staple method, a simple and easily applicable technique even in laparoscopic surgery, significantly reduced the occurrence of CR-POPF among patients undergoing DP.


Assuntos
Pâncreas/cirurgia , Pancreatectomia/efeitos adversos , Fístula Pancreática/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Instrumentos Cirúrgicos , Grampeamento Cirúrgico/métodos , Idoso , Feminino , Humanos , Incidência , Laparoscopia , Masculino , Pancreatectomia/métodos , Fístula Pancreática/epidemiologia , Fístula Pancreática/etiologia , Complicações Pós-Operatórias/etiologia , Análise de Regressão
3.
Ann R Coll Surg Engl ; 101(8): 571-578, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31672036

RESUMO

INTRODUCTION: There are no definitive data concerning the ideal configuration of ileocolic anastomosis. Aim of this study was to identify perioperative risk factors for anastomotic leak and for 60-day morbidity and mortality after ileocolic anastomoses (stapled vs handsewn). MATERIALS AND METHODS: This is a STROBE-compliant study. Demographic and surgical data were gathered from patients with an ileocolic anastomosis performed between November 2010 and September 2016 at a tertiary hospital. Anastomoses were performed using standardised techniques. Independent risk factors for anastomotic leak, complications and mortality were assessed. RESULTS: We included 477 patients: 53.7% of the anastomoses were hand sewn and 46.3% stapled. Laterolateral anastomosis was the most common configuration (93.3%). Anastomotic leak was diagnosed in 8.8% of patients and 36 were classified as major anastomotic leak (7.5%). In the multivariate analysis, male sex (P = 0.014, odds ratio, OR, 2.9), arterial hypertension (P = 0.048, OR 2.29) and perioperative transfusions (P < 0.001, OR 2.4 per litre) were independent risk factors for major anastomotic leak. The overall 60-day complication rate was 27.3%. Male sex (31.3% vs female 22.3%, P = 0.02, OR 1.7), diabetes (P = 0.03 OR 2.0), smoking habit (P = 0.04, OR 1.8) and perioperative transfusions (P < 0.001, OR 3.3 per litre) were independent risk factors for postoperative morbidity. The 60-day-mortality rate was 3.1% and no significant risk factors were identified. CONCLUSION: Anastomotic leak after ileocolic anastomosis is a relevant problem. Male sex, arterial hypertension and perioperative transfusions were associated with major anastomotic leak. Conversion to open surgery was more frequently associated with perioperative death.


Assuntos
Anastomose Cirúrgica/métodos , Fístula Anastomótica/etiologia , Colo/cirurgia , Íleo/cirurgia , Idoso , Anastomose Cirúrgica/efeitos adversos , Feminino , Humanos , Hipertensão/complicações , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Grampeamento Cirúrgico/métodos , Técnicas de Sutura
4.
Anticancer Res ; 39(11): 6393-6401, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31704873

RESUMO

BACKGROUND/AIM: Intracorporeal anastomosis (IA) in laparoscopic colectomy for colon cancer is technically difficult, and there is a lack of consensus on the risk of bacterial contamination and cancer cell dissemination. In this study, short- and long-term outcomes of IA were examined. PATIENTS AND METHODS: Short and long-term outcomes of those who underwent IA (n=44) or extracorporeal anastomosis (EA) (n=61) were compared. RESULTS: IA was better than EA for blood loss, incision length, and first stool. Maximum temperature and C-reactive protein on postoperative day 1 were higher for the IA group. The rate of positive cultures from intraoperative lavage was higher for IA. The rate of positive cultures improved to an equivalent level by replacing mechanical pretreatment with chemical pretreatment. IA and EA were equivalent for the results of ascites cytology from lavage. CONCLUSION: With the use of appropriate preoperative treatment, IA takes advantage of the minimally invasive nature of laparoscopic surgery.


Assuntos
Ascite/microbiologia , Colectomia/métodos , Neoplasias do Colo/cirurgia , Laparoscopia/métodos , Complicações Pós-Operatórias/microbiologia , Grampeamento Cirúrgico/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Feminino , Humanos , Excisão de Linfonodo , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento
5.
Khirurgiia (Mosk) ; (8): 53-58, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31464275

RESUMO

OBJECTIVE: To evaluate the influence of reinforcement of staple line of colorectal anastomosis on the incidence of leakage. MATERIAL AND METHODS: A systematic review was performed in accordance with the PRISMA recommendations. Statistical analysis was carried out in the Review Manager 5.3 software. RESULTS: This trial included four original articles published in 2011-2018. There were 493 patients. Reinforcement of anastomosis was made in 232 (47%) cases, colorectal anastomosis was not reinforced in 261 (53%) patients. Anastomotic leakage rate was 5.6 and 11.1% in both groups, respectively (OR 0.55, CI 0.13-2.33; p=0.42). Transabdominal reinforcement reduced leakage rate by 10.2% (OR 0.18, CI 0.06-0.55; p=0.002) while transanal reinforcement was ineffective (OR 1.66, CI 0.38-7.19; p=0,5). Incidence of preventive stoma was similar (OR 0.3, CI 0.07-1.22; p=0.09), but it was possible to abandon preventive stoma in 18% of cases after anastomotic reinforcement. CONCLUSION: A small number of studies dedicated to anastomosis reinforcement resulted controversial data.


Assuntos
Anastomose Cirúrgica/métodos , Fístula Anastomótica/prevenção & controle , Colo/cirurgia , Protectomia/métodos , Neoplasias Retais/cirurgia , Reto/cirurgia , Anastomose Cirúrgica/efeitos adversos , Fístula Anastomótica/etiologia , Fístula Anastomótica/cirurgia , Humanos , Grampeamento Cirúrgico/efeitos adversos , Grampeamento Cirúrgico/métodos
6.
Transplant Proc ; 51(7): 2225-2227, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31378466

RESUMO

BACKGROUND: Ligation of renal hilus is the most important stage of laparoscopic donor nephrectomy. Laparoscopic staplers are securely used for renal pedicle control. We present our donor nephrectomy cases in which we used 1 stapler for renal artery and vein ligation. METHODS: Demographic data, number of arteries and veins, ligation types, operation time, and complication rates are recorded. RESULTS: One hundred twenty laparoscopic donor nephrectomy cases who were operated between December 2017 and August 2018 in Istinye University Hospital and Istanbul Aydin University Hospital were retrospectively evaluated. All of the operations were done by 2 surgeons with a fully laparoscopic method. None of the cases were converted to open nephrectomy. There was 1 renal artery in 110 (91.7%) cases, 2 renal arteries in 9 (7.5%) cases, and 3 arteries in 1 (0.8%) case. Renal artery and vein were ligated with single stapler in 115 (95.8%) cases. Double stapler was used in 5 (4.2%) patients. There were no major complications for donors and no implantation problems for grafts. DISCUSSION: Laparoscopic donor nephrectomy is the most used technique for living donor operations. Vascular stapler is securely used for renal artery and vein ligation with high costs. Two or, due to the number of vessels, sometimes 3 staplers are used in the standard technique. In our study, the operation was finished securely in 95.8% of the patients with single stapler use. Single stapler use for ligating renal hilus is safe in kidneys even with suitable multiple arteries and veins in laparoscopic donor nephrectomy.


Assuntos
Laparoscopia/métodos , Ligadura/instrumentação , Doadores Vivos , Nefrectomia/métodos , Grampeamento Cirúrgico/instrumentação , Coleta de Tecidos e Órgãos/métodos , Adulto , Feminino , Humanos , Rim/irrigação sanguínea , Transplante de Rim , Ligadura/métodos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Artéria Renal/cirurgia , Estudos Retrospectivos , Grampeamento Cirúrgico/métodos
7.
World J Surg Oncol ; 17(1): 112, 2019 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-31255181

RESUMO

BACKGROUND: Anastomotic leakage (AL) is a common complication after anterior resection of rectal cancer. Few studies have been conducted to determine whether the traditional predictors of AL can be applied to elderly patients (age ≥ 80) undergoing anterior resection (AR) or low anterior resection (LAR) of rectal cancer. This study was designed to explore the predictive factors for AL after anterior resection of rectal cancer in patients over 80 years old. METHODS: From January 2007 to May 2019, consecutive elderly (age ≥ 80) rectal cancer patients undergoing AR or LAR at our institution were systematically reviewed. The general information, perioperative outcomes, and comorbidities were collected. RESULTS: A total of 288 consecutive patients were included in this study. The average age was 82.8 ± 2.4 years, and 30 (10.4%) patients developed AL. The univariate analyses showed that neoadjuvant therapy (50.0% vs. 27.9%, P = 0.013), the number of stapler firings ≥ 3 (60.0% vs. 36.0%, P = 0.011), and coronary heart disease (CHD) (46.7% vs. 17.8%, P < 0.001) were associated with an increased incidence of AL. The multivariate analysis showed that the number of stapler firings ≥ 3 (OR = 4.77, 95% CI = 1.33-15.21, P = 0.035) and CHD (OR = 8.33, 95% CI = 1.94-13.05, P = 0.003) were independent risk factors for AL. CONCLUSION: The number of stapler firings ≥ 3 and CHD were independent risk factors for AL in elderly patients (age ≥ 80) with rectal cancer. A temporary ileostomy or the Hartmann procedure is recommended for patients with CHD, male patients, patients considered to be obese, and patients with a lower tumor location, which may increase the number of stapler firings. Certainly, we recommend that the number of stapler firings should be minimized to alleviate the economic and physical burden of patients.


Assuntos
Fístula Anastomótica/diagnóstico , Laparoscopia/efeitos adversos , Protectomia/efeitos adversos , Neoplasias Retais/terapia , Grampeamento Cirúrgico/efeitos adversos , Fatores Etários , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Fístula Anastomótica/etiologia , Comorbidade , Doença das Coronárias/epidemiologia , Feminino , Humanos , Incidência , Laparoscopia/métodos , Masculino , Terapia Neoadjuvante/efeitos adversos , Terapia Neoadjuvante/métodos , Obesidade/epidemiologia , Protectomia/métodos , Prognóstico , Neoplasias Retais/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Grampeamento Cirúrgico/métodos , Resultado do Tratamento
8.
Vasc Endovascular Surg ; 53(7): 599-601, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31262229

RESUMO

INTRODUCTION: A 90-year-old patient was admitted with a hemorrhagic shock from a huge ruptured abdominal aortic aneurysm with an unfavourable infrarenal aortic neck and a horseshoe kidney (HSK). REPORT: We decided on an open surgical approach: the HSK isthmus was sectioned with an Endo GIA 45 mm, and we performed a suprarenal aortic cross-clamping and an aortic graft reconstruction. Postoperatively, no urinary leakage was detected, and renal function showed no impairment. The patient died on the 10th postoperative day from pneumonia. CONCLUSION: We believe that the sectioning of the HSK isthmus with Endo GIA is a fast and simple maneouvre.


Assuntos
Aneurisma Roto/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/métodos , Rim Fundido/complicações , Grampeamento Cirúrgico/métodos , Idoso de 80 Anos ou mais , Aneurisma Roto/complicações , Aneurisma Roto/diagnóstico por imagem , Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aortografia/métodos , Prótese Vascular , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Angiografia por Tomografia Computadorizada , Evolução Fatal , Feminino , Rim Fundido/diagnóstico por imagem , Humanos , Pneumonia/etiologia , Choque Hemorrágico/etiologia , Grampeadores Cirúrgicos , Grampeamento Cirúrgico/efeitos adversos , Grampeamento Cirúrgico/instrumentação , Resultado do Tratamento
9.
Medicine (Baltimore) ; 98(24): e15978, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31192938

RESUMO

BACKGROUND: Colorectal anastomotic leakage (AL) is one of the most serious complications in rectal cancer surgery due to its negative impact on the overall as well as cancer-specific survival. Two-row stapling technique has become standard in low anterior resections (LARs), but has neither alleviated the morbidity, nor reduced the incidence of AL. This is the 1st study that aims to compare the success rate of new 3-row circular staplers compared to that of conventional 2-row staplers in a prospective, randomized clinical trial. METHODS: The THREESTAPLER trial (Clinical Trials NCT03910699) is a prospective, noninferiority, 2-armed, parallel-group, patient and outcomes assessor blinded study with a 1:1 allocation ratio. Colorectal anastomosis will be formed using Ethicon 29 mm Curved Intraluminal Stapler (CDH29A) in the active comparator group, and using Mirus Disposable Circular Stapler 3 Row 29 (MCS-29R3) in the experimental group. The hypothesis states that the incidence of AL in the 3-row stapler group is at least not higher than in the 2-row stapler group. Assuming there is a difference in success rate of 12% and noninferiority margin Δ = 5%, 154 patients will be required to achieve statistical significance. An interim analysis will be performed after recruitment of 20 patients per group to assess safety profile of 3-row circular staplers. The primary endpoint is the rate of AL, documented by imaging studies, assessed with Pearson Chi-squared test and Fisher exact test. The secondary outcomes include severity of AL (A, B, or C), anastomotic bleeding, postoperative complication rate graded with the Clavien-Dindo classification, reintervention rate, stapler dysfunction rate, complications of defunctioning stoma, overall and cancer-specific quality of life, assessed with short form (36) and quality-of-life questionnaire core 30 questionnaires, respectively, fecal incontinence assessed with Cleveland clinic incontinence score form, and manifestation of LAR syndrome. All patients will be monitored for 12 months following the LAR. DISCUSSION: This is the 1st prospective randomized trial to assess the safety profile of 3-row staplers for colorectal anastomosis after LAR for rectal cancer. It may provide evidence of feasibility of 3-row circular staplers in LAR with respect to short-term and long-term patient outcomes. TRIAL REGISTRATION: NCT03910699 on 10 April 2019.


Assuntos
Anastomose Cirúrgica/métodos , Fístula Anastomótica/cirurgia , Neoplasias Colorretais/cirurgia , Complicações Pós-Operatórias/cirurgia , Anastomose Cirúrgica/instrumentação , Fístula Anastomótica/epidemiologia , Fístula Anastomótica/etiologia , Feminino , Humanos , Incidência , Masculino , Complicações Pós-Operatórias/psicologia , Estudos Prospectivos , Qualidade de Vida/psicologia , Padrão de Cuidado , Grampeadores Cirúrgicos , Grampeamento Cirúrgico/métodos , Análise de Sobrevida , Resultado do Tratamento
10.
J Laparoendosc Adv Surg Tech A ; 29(10): 1216-1222, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31150305

RESUMO

Background: Laparoscopic duodenal atresia (DA) repair is a demanding procedure that requires performing a watertight anastomosis in a small working space. Drawbacks of the approach have been high leakage rates and long operative times. In this article, we evaluate our initial experience with DA repair using a laparoscopic miniature stapler (LA-MS) and compared outcomes with a historic cohort of laparoscopic hand-sewn (LA-HS) and open repairs (ORs). Materials and Methods: A retrospective analysis of all patients who underwent surgery for DA at our two centers between January 2010 and April 2018 was performed. Demographics, comorbidities, intra- and postoperative data, and outcome parameters were evaluated and statistically analyzed. Results: DA repair was performed in 44 patients. Ten patients underwent laparoscopic DA repair using an MS, 21 patients laparoscopic repair with HS anastomosis, and 13 patients underwent OR. Median age and weight at surgery was 13.5 days (range: 2-173) and 3300 g (range: 1630-5600) in the LA-MS group, 4 days (range: 2-269) and 2750 g (range: 1700-4095) in the LA-HS group and 4 days (range: 1-17) and 2222 g (range: 1520-3590) in the OR group, respectively. Mean operative time was significantly shorter in the laparoscopic stapled group compared with LA-HS group (145 ± 37 minutes (range: 97-217) versus 201 ± 47 minutes (range: 119-275), P < .004). Duodenojejunostomy was performed more frequently in the laparoscopic stapled group compared with the open procedure (P = .008). Overall complication rate was similar between groups. Time to initiation of feeds and time to full feeds were significantly shorter in the laparoscopic stapled group compared with the open approach (5 versus 11.9 days, P = .041 and 14.5 versus 24.4 days, P = .020). Conclusion: Laparoscopic DA repair using an MS is a novel, safe, and feasible technique that was associated with significantly shorter operating times than HS laparoscopic DA repair. Owing to its simplicity, this technique has the potential to become the new standard of care.


Assuntos
Obstrução Duodenal/cirurgia , Atresia Intestinal/cirurgia , Laparoscopia/instrumentação , Grampeadores Cirúrgicos , Grampeamento Cirúrgico/instrumentação , Anastomose Cirúrgica/instrumentação , Anastomose Cirúrgica/métodos , Feminino , Humanos , Lactente , Recém-Nascido , Laparoscopia/métodos , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Grampeamento Cirúrgico/métodos , Resultado do Tratamento
11.
BMJ Case Rep ; 12(5)2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31151978

RESUMO

Recurrent tracheo-oesophageal fistula (TOF) is a common complication in children who underwent oesophageal atresia repair. The traditional surgical approach performed either by thoracotomy or cervicotomy is associated with a high rate of morbidity, mortality and new recurrence. In the last decades, endoscopic techniques have emerged as the minimally invasive alternative. However, it seems that the optimal treatment is still unknown. We present a patient with a recurrent TOF who underwent thoracoscopic closure using a 5.8 mm endostapler. The patient was extubated at the end of the procedure, and he started feeding the day after surgery. At 15 months of follow-up, he is asymptomatic. Thoracoscopic closure of TOF using endostaplers seems to be a safe alternative with some possible benefits compared with traditional and endoscopic approach.


Assuntos
Grampeadores Cirúrgicos , Grampeamento Cirúrgico/métodos , Toracoscopia/métodos , Fístula Traqueoesofágica/cirurgia , Humanos , Recém-Nascido , Masculino , Recidiva , Grampeamento Cirúrgico/instrumentação , Resultado do Tratamento
12.
Medicine (Baltimore) ; 98(23): e15676, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31169669

RESUMO

BACKGROUND: Many studies have been conducted to compare the hand-sewn and mechanical staples in esophageal cancer (EC) patients who received esophagogastric anastomosis. However, the results remain controversial. Hence, the purpose of the meta-analysis is to evaluate the impact of different anastomosis methods on the early and long-term outcomes. METHODS: We will perform a systematic electronic search of the PubMed, Embase, Cochrane Library, Web of Science for relevant articles published in English language. Pooled odds ratios will be calculated for the effect on discrete variables including anastomotic leakage, anastomotic strictures, 30-day mortality, quality of life, cardiac and pulmonary complications. The weighted mean difference was calculated for the effect size on continuous variables such as operative time and bleeding amount. We will use the software Review Manager 5.3 and STATA 14.0 to perform the meta-analysis to calculate the data synthesis. RESULTS: The review will provide a high-quality synthesis of current evidence of the impact of different anastomosis methods on postoperative course in ECs after esophagectomy. The results will be published in a peer-reviewed journal. CONCLUSION: This systematic review and meta-analysis will compare the different anastomosis methods in EC patients. The results will better offer some specific suggestions for esophagogastric anastomosis. PROSPERO REGISTRATION NUMBER: This systematic review protocol has been registered in the PROSPERO network (No. CRD 42019109523).


Assuntos
Neoplasias Esofágicas/cirurgia , Esôfago/cirurgia , Estômago/cirurgia , Grampeamento Cirúrgico/estatística & dados numéricos , Técnicas de Sutura/estatística & dados numéricos , Anastomose Cirúrgica/métodos , Feminino , Humanos , Masculino , Metanálise como Assunto , Projetos de Pesquisa , Grampeamento Cirúrgico/métodos , Revisão Sistemática como Assunto , Resultado do Tratamento
13.
J Coll Physicians Surg Pak ; 29(7): 661-664, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31253220

RESUMO

OBJECTIVE: To compare three reinforcement options (suture, fibrin glue, and no reinforcement) for staple line reinforcement of patients undergoing laparoscopic sleeve gastrectomy. STUDY DESIGN: An experimental study. PLACE AND DURATION OF STUDY: Ortadogu Hospital, Adana, Turkey, from 2013 to 2017. METHODOLOGY: The inclusion criteria were patients with BMI > 40 Kg/m² or >35 Kg/m² (if there were comorbid diseases associated with obesity). The exclusion criteria were patients who were older than 65 years or had a bariatric procedure earlier. The patients were placed in three groups. Group 1 had no staple line reinforcement, group 2 had fibrin glue on the staple line, and group 3 had barbed continued suture on the staple line. The primary endpoints included stenosis, bleeding, and postoperative leaks. The secondary outcomes included total operation time and time for staple line reinforcement. Values of p<0.05 were deemed significant for all statistical tests. RESULTS: The mean time to perform the staple line reinforcement was significantly higher in group 3 (22.05 ± 2.83 minutes) than in group 2 (fibrin glue, 10.86 ± 2.15 minutes, p<0.001). The mean total operation times were significantly different between all three groups; 70.8 ± 5.4 minutes for group 1, 74.7 ± 6.2 minutes for group 2, and 81.2 ± 3.0 minutes for group 3 (p<0.001). The groups had no statistical differences regarding complications. CONCLUSION: The use of fibrin glue and barbed continuous suture for staple line reinforcement during laparoscopic sleeve gastrectomy had no effect on post- or per-operative hemorrhage and leakage; however, these procedures significantly extended the operation time.


Assuntos
Gastrectomia , Laparoscopia , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Grampeamento Cirúrgico/métodos , Adulto , Feminino , Adesivo Tecidual de Fibrina , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Grampeamento Cirúrgico/instrumentação , Suturas , Turquia , Adulto Jovem
14.
Br J Surg ; 106(9): 1147-1155, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31233220

RESUMO

BACKGROUND: Colonic J pouch reconstruction has been found to be associated with a lower incidence of anastomotic leakage than straight anastomosis. However, studies on this topic are underpowered and retrospective. This randomized trial evaluated whether the incidence of anastomotic leakage was reduced after colonic J pouch reconstruction compared with straight colorectal anastomosis following anterior resection for rectal cancer. METHODS: This multicentre RCT included patients with rectal carcinoma who underwent low anterior resection followed by colorectal anastomosis. Patients were assigned randomly to receive a colonic J pouch or straight colorectal anastomosis. The main outcome measure was the occurrence of major anastomotic leakage. The incidence of global (major plus minor) anastomotic leakage and general complications were secondary outcomes. Risk factors for anastomotic leakage were identified by regression analysis. RESULTS: Of 457 patients enrolled, 379 were evaluable (colonic J pouch arm 190, straight colorectal arm 189). The incidence of major and global anastomotic leakage, and general complications was 14·2, 19·5 and 34·2 per cent respectively in the colonic J pouch group, and 12·2, 19·0 and 27·0 per cent in the straight colorectal anastomosis group. No statistically significant differences were observed between the two arms. In multivariable logistic regression analysis, male sex (odds ratio 1·79, 95 per cent c.i. 1·02 to 3·15; P = 0·042) and high ASA fitness grade (odds ratio 2·06, 1·15 to 3·71; P = 0·015) were independently associated with the occurrence of anastomotic leakage. CONCLUSION: Colonic J pouch reconstruction does not reduce the incidence of anastomotic leakage and postoperative complications compared with conventional straight colorectal anastomosis. Registration number NCT01110798 (http://www.clinicaltrials.gov).


Assuntos
Colo/cirurgia , Bolsas Cólicas , Procedimentos Cirúrgicos Reconstrutivos , Neoplasias Retais/cirurgia , Reto/cirurgia , Grampeamento Cirúrgico , Idoso , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Fístula Anastomótica/epidemiologia , Fístula Anastomótica/etiologia , Bolsas Cólicas/efeitos adversos , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Grampeamento Cirúrgico/métodos
16.
World J Surg ; 43(10): 2483-2489, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31222637

RESUMO

BACKGROUND: Several techniques have been described for esophagogastric anastomosis following esophagectomy. This study compared the outcomes of circular stapled anastomoses with semi-mechanical technique using a linear stapler. METHODS: Perioperative data were extracted from a contemporaneously collected database of all consecutive esophagectomies for cancer with intrathoracic anastomoses performed in the Trent Oesophago-Gastric Unit between January 2015 and April 2018. Anastomotic techniques: circular stapled versus semi-mechanical, were evaluated and outcomes were compared. The primary outcome was anastomotic leak rate. Secondary outcomes included anastomotic stricture, overall complication rates, length of stay (LOS) and 30 day all-cause mortality. RESULTS: One hundred and fifty-nine consecutive esophagectomies with intrathoracic anastomosis were performed during the study period. There were no significant differences between the two groups in terms of age, American Society of Anaesthesiologists score, Charlson comorbidity index and neoadjuvant therapies received. Circular stapled anastomoses were performed in 85 patients, while 74 patients received a semi-mechanical anastomosis. Clavien-Dindo complications II or more were higher in the circular stapled group (p = 0.02). There were 16 (10%) anastomotic leaks overall, three (4%) in semi-mechanical group versus 13 (15%) in the circular stapled group (p < 0.019). There was no statistically significant difference between the two groups in terms of LOS, 30-day mortality or the need for endoscopic dilatation of the anastomosis at 3 months follow-up. CONCLUSION: The move from a circular stapled to a semi-mechanical intrathoracic anastomosis has been associated with a reduced postoperative anastomotic leak rate following esophagectomy for esophageal cancer.


Assuntos
Anastomose Cirúrgica/métodos , Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Grampeamento Cirúrgico/métodos , Idoso , Anastomose Cirúrgica/efeitos adversos , Fístula Anastomótica/epidemiologia , Bases de Dados Factuais , Esofagectomia/instrumentação , Esofagectomia/mortalidade , Feminino , Seguimentos , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Técnicas de Sutura , Resultado do Tratamento
17.
J Surg Res ; 242: 136-144, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31077945

RESUMO

BACKGROUND: Intraoperative testing of anastomoses and staples lines is commonly performed to minimize the risk of postoperative leaks in bariatric surgery, but its impact is unclear. The aim of this study was to determine the association between leak testing and 30-d postoperative leak, bleed, reoperation, and readmission rates for patients undergoing laparoscopic sleeve gastrectomy (LSG) or Roux-en-Y gastric bypass (RYGB). METHODS: This is a retrospective observational study utilizing 2015-2016 data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database. Postoperative outcomes were compared using χ2 test. Multivariable logistic regression was used to identify factors associated with 30-d outcomes. RESULTS: We included 237,081 patients. Leak testing was performed on 73.0% and 92.1% of LSG and RYGB patients, respectively. LSG was associated with lower rates of leak, bleed, reoperation, and readmission than RYGB. On multivariable analysis, intraoperative leak testing was associated with increased rates of postoperative leak for LSG and RYGB (OR 1.48 and 1.90, respectively) and lower rates of bleed for LSG (OR 0.76). There were no significant associations between leak testing and rates of reoperation or readmission. CONCLUSIONS: Use of intraoperative leak testing was not associated with improved outcomes for either LSG or RYGB. A prospective trial investigating leak testing is warranted to better elucidate its impact.


Assuntos
Fístula Anastomótica/prevenção & controle , Cirurgia Bariátrica/efeitos adversos , Cuidados Intraoperatórios/métodos , Obesidade Mórbida/cirurgia , Hemorragia Pós-Operatória/prevenção & controle , Adulto , Fístula Anastomótica/epidemiologia , Cirurgia Bariátrica/métodos , Feminino , Gastrectomia/efeitos adversos , Gastrectomia/métodos , Humanos , Cuidados Intraoperatórios/efeitos adversos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Hemorragia Pós-Operatória/epidemiologia , Hemorragia Pós-Operatória/etiologia , Período Pós-Operatório , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Grampeamento Cirúrgico/efeitos adversos , Grampeamento Cirúrgico/métodos , Resultado do Tratamento
18.
Surg Innov ; 26(4): 408-419, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31056009

RESUMO

Purpose. Clinically apparent anastomotic leakage (AL) after low anterior rectal resection (LAR; <7 cm from anal verge) using circular double-stapled anastomosis without defunctioning stoma is up to 37.5%. However, it is unclear whether there is reduction of LAR after 21 postoperative days without defunctioning stoma but with extraluminal anastomotic application of fibrin sealant. Methods. Forty-eight-week-old pigs underwent LAR and circular double-stapled anastomosis in end-to-end technique (descendo-rectostomy). Animals were randomized into therapy and control group (cg). Therapy group (n = 20) received additional extraluminal circular anastomotic application of fibrin sealant. Objective was to assess incidence of clinically apparent and nonclinically apparent leakage through the 21st postoperative day. Remaining animals were sacrificed on the 21st day, and anastomotic region was analyzed. In case of earlier diagnosed AL, animals were sacrificed. Results. In cg, we observed clinically and nonclinically AL in 20% (n = 4). No animal was identified with a nonclinical-apparent leakage in this group, and all 4 animals with leakages presented clinical signs. In the therapy group, no animal (0/20) developed clinically apparent leakage signs. There were no leakages in this group, but 3 animals had ulcerative lesions without leak and without clinical signs. These lesions were observed intraluminally at crossing of staple lines after 21 days. In one of these animals, incomplete leakage was observed, blocked by fibrin sealant. Conclusion. In circular stapled colorectal anastomosis, circular fibrin glue sealant successfully protected anastomotic intraluminal wall defects at crossing of staple lines, reducing leakage rate from 20% to 0% (cg vs therapy group) after 21 postoperative days.


Assuntos
Anastomose Cirúrgica/métodos , Fístula Anastomótica/prevenção & controle , Adesivo Tecidual de Fibrina/uso terapêutico , Reto/cirurgia , Grampeamento Cirúrgico/métodos , Animais , Modelos Animais , Suínos
19.
Orv Hetil ; 160(16): 629-635, 2019 Apr.
Artigo em Húngaro | MEDLINE | ID: mdl-30983402

RESUMO

INTRODUCTION AND AIM: We present our experience with open (transcervical diverticulectomy, cricomyotomy) and transoral surgery (transoral stapler diverticulostomy) for Zenker diverticulums. METHOD: Between 1 January 2006 and 31 December 2016, 29 patients were examined with a symptom-causing Zenker diverticulum. In 13 cases, transcervical surgery, in 16 cases, transoral surgery were performed. Perioperative and long-term results were evaluated and compared. RESULTS: Patients were operated on after an average of 31 months with complaints. In both groups, the leading symptoms were severe dysphagia and severe regurgitation. No intraoperative complication was detected. In the transoral group, one patient had to be reoperated on for bleeding, another patient developed pneumonia in the transcervical group. The average duration of the surgeries (42.5 versus [vs.] 98 minutes, p<0.001), the time to oral feeding (2.9 vs. 4.6 days, p<0.001) and the mean hospital stay (7.3 vs. 9.7 days, p<0.001) were significantly shorter in the transoral group than the transcervical group. 15 patients were completely symptomless postoperatively. After transcervical treatment, complaints were developed in 2 cases (moderate dysphagia and hoarseness). After transoral surgery, recurrent symptoms were observed in 6 patients, 4 had to be reoperated transcervically due to severe regurgitation. CONCLUSION: Transoral stapler diverticulostomy is a fast procedure and offers short hospital stay especially in comorbid, aged patients and intermedium diverticulum size. In the long term, some of the patients may require reintervention due to persistent regurgitation. The transcervical approach has higher perioperative morbidity, which can be performed in patients with less than 3 cm or large diverticulum size. Orv Hetil. 2019; 160(16): 629-635.


Assuntos
Transtornos de Deglutição/etiologia , Diverticulite/cirurgia , Esofagoscopia/métodos , Grampeamento Cirúrgico/métodos , Divertículo de Zenker/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Diverticulite/diagnóstico , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Complicações Pós-Operatórias , Qualidade de Vida , Recuperação de Função Fisiológica , Estudos Retrospectivos , Grampeadores Cirúrgicos , Fatores de Tempo , Resultado do Tratamento , Divertículo de Zenker/diagnóstico
20.
Med Hypotheses ; 126: 60-65, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31010501

RESUMO

Every year millions of lacerations and incisions taken place and require an effective methodology to manage the wound for a better life. The primary causes include mechanical trauma and surgical procedures. The rapid healing of the wound is critical to prevent further infection and reduction pain etc. Current options comprise of sutures, staplers, surgical strips and glues, again the intervention depends on the type of wound and the surgeon preference. The current wound closure techniques pose various potent limitations and confronting the problems to create a desired wound closure technique is necessary for faster and effective wound healing management. The surgical staplers are fast and easy to use wound closure devices, which approximates the edges of the wounds together by staples. The staples are mostly made up of metals like titanium and stainless steel. By modifying the existing stapling method using biodegradable staples that are expected to have good mechanical properties, not require removal procedure, minimized scarring and an overall acceleration in wound healing with minimal complications. Present, the paper focuses on the novel hypothesis on natural fiber reinforced biodegradable polymer staples as wound enclosures with high strength and degradability.


Assuntos
Materiais Biocompatíveis/química , Procedimentos Cirúrgicos Dermatológicos , Grampeamento Cirúrgico/métodos , Técnicas de Sutura/instrumentação , Suturas , Cicatrização , Animais , Humanos , Modelos Teóricos , Polímeros/química , Infecção da Ferida Cirúrgica , Ferimentos e Lesões/terapia
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