Use of Teflon pledgets in esophageal anastomoses

Evaluation of porcine-derived small intestine submucosa as a biodegradable graft for gastrointestinal healing

High-risk anastomoses in the gut may benefit from the application of a synthetic reinforcement to prevent an enteric leak. Recently a porcine-derived small intestine submucosa (SIS) was tested as a bioscaffold in a number of organ systems. The aim of this study was to evaluate the effectiveness of SIS in stimulating healing in the stomach. Twelve rats underwent surgical removal of a full-thickness gastric defect (1 cm) and subsequent repair with a double-layer patch of porcine-derived SIS. The graft was secured with interrupted sutures placed within 1 mm of the edge of the graft. After 21 days, the animals were killed and their stomachs harvested for histologic examination. Cross sections were processed for paraffin embedding and 4-micron sections were stained with hematoxylin and eosin. All animals survived, gained weight, and demonstrated no signs of peritonitis over the 3-week postoperative period. On postmortem examination, the defect was completely closed in all animals by granulation tissue and early fibrosis. Although most of the luminal surface of the grafted areas remained ulcerated, early regeneration of normal gastric mucosa was seen at the periphery of the defect. SIS may act as an effective scaffolding agent for intestinal mucosa and may offer protection in high-risk anastomoses.

External annular prosthesis in repair of biliary tract stricture

A surgical technique for treatment of benign intrahepatic or extrahepatic biliary stenosis is described. It is based on the use of annular prostheses of Teflon placed around the outside of the anastomotic line using appropriate surgical instruments. This procedure leaves the blood supply to the bile duct intact, achieves hermetic apposition of epithelia, and prevents leakage of bile. It eliminates the use of intraductal splints, avoids retraction of scar tissue around the anastomotic zone, and increases or maintains the internal diameter of the biliary duct on the anastomotic line. The technique has been used in 33 patients with follow-up from 1 to 10 years. Excellent results were achieved in 32 patients, with 1 patient having a poor result. The average postoperative hospital stay was only 6 days.