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Manolesou DG, Georgiopoulos G, Lazaris AM, Schizas D, Stamatelopoulos KS, Khir AW, Liakakos T, Papaioannou TG. Experimental Devices Versus Hand-Sewn Anastomosis of the Aorta: A Systematic Review and Meta-Analysis. J Surg Res 2020; 258:200-212. [PMID: 33035743 DOI: 10.1016/j.jss.2020.08.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/27/2020] [Accepted: 08/30/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND To minimize complications associated with the construction of the hand-sewn aortic anastomosis, alternative experimental methods have been pursued. This study aimed to evaluate the efficacy of experimental anastomotic devices in relation to time and point of rupture of the anastomosis in comparison to the conventional technique. MATERIALS AND METHODS An electronic search was performed using MEDLINE, Scopus, Science Direct, and Cochrane Library databases by two independent authors. Our exclusion criteria referred to studies reporting results solely from end-to-side anastomosis, results on vessels other than the aorta, studies that did not involve animal experiments, and non-English publications. The last search date was January 1, 2020. RESULTS The meta-analysis included 22 studies with 34 anastomosis samples and a total of 316 animals. The pooled mean automated anastomosis time was 10.38 min, and the mean point of rupture was 32.7 N. In the subgroup analysis of automated anastomosis time by device category, the anastomotic stenting technique reported significantly lower anastomosis time but also showed significantly lower point of rupture. Comparing the efficacy of experimental devices and the hand-sewn technique, our pooled analysis showed that automated devices significantly decrease the time needed to perform the anastomosis (weighted mean difference -7.24 min). On the other hand, the automated anastomosis is also associated with decreased tensile strength (weighted mean difference -20.68 N). CONCLUSIONS Although experimental devices seem to offer a faster anastomosis, they lack endurance when compared with the hand-sewn technique. Further research is needed for the development of an "ideal" anastomotic technique.
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Affiliation(s)
- Danae G Manolesou
- Biomedical Engineering Unit, First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - George Georgiopoulos
- School of Biomedical Engineering and Imaging Sciences, King's College London, London UK
| | - Andreas M Lazaris
- Department of Vascular Surgery, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Schizas
- First Department of Surgery, Laiko Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Kimon S Stamatelopoulos
- Vascular Laboratory, Department of Clinical Therapeutics, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ashraf W Khir
- Brunel Institute for Bioengineering, Brunel University London, London, UK
| | - Theodoros Liakakos
- First Department of Surgery, Laiko Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodore G Papaioannou
- Biomedical Engineering Unit, First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Manolesou D, Papaioannou TG, Georgiopoulos G, Schizas D, Lazaris A, Stamatelopoulos K, Dimakakos E, Stergiopulos N, Stefanadis C, Liakakos T, Tousoulis D. Α systematic review and meta-analysis of the efficacy of aortic anastomotic devices. J Vasc Surg 2019; 69:598-613.e7. [PMID: 30683205 DOI: 10.1016/j.jvs.2018.08.154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 08/09/2018] [Indexed: 01/16/2023]
Abstract
OBJECTIVE One of the factors contributing to complications related to open repair of the aorta is the construction of a hand-sewn anastomosis. Aortic anastomotic devices (AADs), such as the intraluminal ringed graft (IRG), and the anastomotic stenting technique have been developed to perform a sutureless and less complicated anastomosis. This study performed a systematic review and meta-analysis of the literature reporting clinical use of AADs and aimed to assess, primarily, the effect of each device on 30-day overall and operation-related mortality and aortic cross-clamping time and, secondarily, the rate of successful two-sided application of the IRG device and the operation-related morbidity for each device. METHODS An electronic search was performed using MEDLINE, Scopus, ScienceDirect, and Cochrane Library by two independent authors. Our exclusion criteria included studies incorporating fewer than three patients and studies reporting results solely from animals or in vitro testing, results solely from end-to-side anastomosis, and results solely from endarterectomy procedures. The last search date was February 1, 2018. RESULTS A total of 41 studies were identified that reported outcomes for the use of three different device types: IRG, anastomotic stenting technique, and surgical staplers. The last two types were classified together as the non-IRG group. The meta-analysis included 27 studies with 50 cohorts incorporating 1260 patients. The median age of the incorporated patients was 61.4 years (range, 51-73 years), and 68.9% were male. The operations were performed for the treatment of acute aortic dissection in 82.3%. The pooled overall 30-day mortality rate varied by device type; IRG devices had a mean rate of all-cause mortality of 9.71%, whereas non-IRG devices were associated with a significantly (I2 = 15.78%; P for Cochrane Q test < .19) lower rate of death (1.47%). The pooled mean aortic cross-clamping time was 35.83 minutes. Metaregression showed that the performance of two-sided anastomosis with the IRG device significantly decreased the aortic cross-clamping time. However, a successful two-sided ringed anastomosis was performed in approximately half of the cases. CONCLUSIONS Taking into account that the majority of operations were performed for the treatment of acute aortic dissection, AADs had a relatively low rate of 30-day mortality. Despite the observed heterogeneity in study protocols and the small sample size in the non-IRG group, the non-IRG group presented with the lowest 30-day mortality rate. Specific device-related complications between the different device types need further investigation.
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Affiliation(s)
- Danae Manolesou
- Biomedical Engineering Unit, First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Theodore G Papaioannou
- Biomedical Engineering Unit, First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - George Georgiopoulos
- Vascular Laboratory, Department of Therapeutics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Schizas
- First Department of Surgery, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Andreas Lazaris
- Department of Vascular Surgery, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Kimonas Stamatelopoulos
- Vascular Laboratory, Department of Therapeutics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Dimakakos
- Vascular Unit, 3rd Internal Medicine Clinic, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Stergiopulos
- Laboratory of Hemodynamics and Cardiovascular Technology, Institute of Biotechnology, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | | | - Theodoros Liakakos
- First Department of Surgery, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Tousoulis
- Biomedical Engineering Unit, First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Jones CT, Chen CY, Campbell BG, Fransson BA. Assessment of leakage pressure following enterotomy closure reinforced by tissue adhesive in a caprine cadaver model. N Z Vet J 2017. [DOI: 10.1080/00480169.2017.1344586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- CT Jones
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA 99164-6610, USA
| | - CY Chen
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA 99164-6610, USA
- Atlantic Veterinary College, University of Prince Edward Island, 550 University Avenue, Charlottetown, Prince Edward Island, Canada C1A 4P3
| | - BG Campbell
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA 99164-6610, USA
| | - BA Fransson
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA 99164-6610, USA
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Lange F, Domergue S, Meziane J, Fassio E, Yachouh J. [Techniques of anastomoses issue from vascular surgery and apply to maxillofacial microsurgery]. ANN CHIR PLAST ESTH 2011; 57:254-9. [PMID: 22153893 DOI: 10.1016/j.anplas.2011.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 10/18/2011] [Indexed: 10/14/2022]
Abstract
Vascular surgeons use an anastomosis technique that has proven its efficiency for a long time. This technique consists in an anastomosis with spatulated ended vessels designed with opposite obliquity. This anastomosis is closed by a continuous suture. Authors expose the results of this technique applied to microvascular surgery in facial reconstruction.
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Affiliation(s)
- F Lange
- Service de chirurgie maxillofaciale et plastique, CHU Lapeyronie, 371 avenue du Doyen-Gaston-Giraud, Montpellier, France.
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Schwaiger N, Wu J, Wright B, Morrissey L, Harris M, Rohanizadeh R. BioWeld® Tube and surgical glue for experimental sutureless venous microanastomosis. Br J Surg 2010; 97:1825-30. [DOI: 10.1002/bjs.7257] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2010] [Indexed: 11/06/2022]
Abstract
Abstract
Background
The medial wall of mammalian veins is generally thin and fragile compared with the thick muscle seen in arteries. This makes venous microanastomoses time consuming and challenging. This study aimed to determine the feasibility and effectiveness of using the BioWeld® Tube in conjunction with a surgical glue (butyl-2-cyanoacrylate) in performing sutureless venous microanastomoses.
Methods
The feasibility and effectiveness of microvascular anastomoses in a rabbit jugular vein model were investigated in six animals, using the BioWeld® Tube in conjunction with butyl-2-cyanoacrylate surgical glue. Patency and tissue repair mechanisms at the anastomotic site were assessed 1 week after the procedure.
Results
All anastomoses remained patent at 1 week. Muscle necrosis occurred only in areas where the tissue was subject to the fold-and-bond procedure.
Conclusion
The study showed the feasibility and short-term effectiveness of the BioWeld® Tube in facilitating venous anastomoses.
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Affiliation(s)
- N Schwaiger
- Clinic for Hand-, Plastic- and Microsurgery Friederikenstift, Hanover, Germany
| | - J Wu
- Victor Chang Cardiac Research Institute, University of Wollongong, Sydney, New South Wales, Australia
| | - B Wright
- Eddyline, University of Wollongong, Sydney, New South Wales, Australia
| | - L Morrissey
- Graduate School of Medicine, University of Wollongong, Sydney, New South Wales, Australia
| | - M Harris
- TM Ventures, University of Sydney, Sydney, New South Wales, Australia
| | - R Rohanizadeh
- Faculty of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
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Surgical adhesive increases burst pressure and seals leaks in stapled gastrojejunostomy. Surg Obes Relat Dis 2010; 6:498-501. [PMID: 20176513 DOI: 10.1016/j.soard.2009.11.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Revised: 10/12/2009] [Accepted: 11/05/2009] [Indexed: 12/19/2022]
Abstract
BACKGROUND Leakage from a gastrointestinal anastomosis in bariatric surgery is a catastrophic complication and is the second-most preventable cause of death after Roux-en-Y gastric bypass. Several adjuncts for staple line reinforcement have been investigated to reduce the incidence of this complication. The purpose of our study was to determine whether a commercially available tissue sealant (BioGlue) could reinforce a stapled gastrojejunal anastomosis and whether it could seal an artificially created anastomotic leak. METHODS Circular-stapled gastrojejunostomies were performed on freshly explanted porcine stomach and intestine. Experiment 1 consisted of 10 control nonreinforced gastrojejunostomies and 10 gastrojejunostomies reinforced with BioGlue. The staple lines were submerged in saline and exposed to increased pressure using constant-rate infusion of air. The burst pressures were recorded at the point of visible leakage from the anastomosis. In experiment 2, a small defect was created in 10 gastrojejunostomies. The burst pressures were recorded before and after application of BioGlue to the anastomosis. The data were analyzed using the 2-tailed paired t test. RESULTS In experiment 1, the burst pressure was significantly increased in the reinforced gastrojejunostomies, from 27.4 ± 8.4 mm Hg to 59.1 ± 19.2 mm Hg (P <.001). In experiment 2, the defective gastrojejunostomies had an average burst pressure of 1.2 ± 0.8 mm Hg. After application of BioGlue, the burst pressure increased to 42.8 ± 15.9 mm Hg (P <.001). CONCLUSION These ex vivo findings suggest that the surgical adhesive BioGlue can reinforce both intact and defective stapled gastrojejunal anastomoses. Additional in vivo study is warranted to determine whether BioGlue can prevent or help seal gastrojejunal leaks.
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Lemaire SA, Ochoa LN, Conklin LD, Schmittling ZC, Undar A, Clubb FJ, Li Wang X, Coselli JS, Fraser CD. Nerve and Conduction Tissue Injury Caused by Contact with BioGlue. J Surg Res 2007; 143:286-93. [PMID: 17765925 DOI: 10.1016/j.jss.2006.10.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2006] [Revised: 10/04/2006] [Accepted: 10/09/2006] [Indexed: 10/22/2022]
Abstract
BACKGROUND BioGlue-a surgical adhesive composed of bovine albumin and glutaraldehyde-is commonly used in cardiovascular operations. The objectives of this study were to determine whether BioGlue injures nerves and cardiac conduction tissues, and whether a water-soluble gel barrier protects against such injury. MATERIALS AND METHODS In 18 pigs, diaphragmatic excursion during direct phrenic nerve stimulation was measured at baseline and at 3 and 30 min after nerve exposure to albumin (n = 3), glutaraldehyde (n = 3), BioGlue (n = 6), or water-soluble gel followed by BioGlue (n = 6). Additionally, BioGlue was applied to the cavoatrial junction overlying the sinoatrial node (SAN), either alone (n = 12) or after application of gel (n = 6). RESULTS Mean diaphragmatic excursions in the BioGlue and glutaraldehyde groups were lower at 3 min and 30 min than in the albumin group (P < 0.05). Mean excursions in the gel group were similar to those of the albumin group (P = 0.9). Five BioGlue pigs (83%) and one gel pig (17%) had diaphragmatic paralysis by 30 min (P < 0.05 and P = 0.3 versus albumin, respectively). Coagulation necrosis extended into the myocardium at the cavoatrial junction in all 12 BioGlue pigs but only two gel pigs (33%, P < 0.01). Two BioGlue pigs (17%), but no gel pigs, had focal SAN degeneration and persistent bradycardia (P < 0.01). CONCLUSIONS BioGlue causes acute nerve injury and myocardial necrosis that can lead to SAN damage. A water-soluble gel barrier is protective.
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Affiliation(s)
- Scott A Lemaire
- Cardiovascular Surgery Service, the Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas 77030, USA.
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