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Wang W, Korah M, Bessoff KE, Shen J, Forrester JD. Xanthogranulomatous inflammation requiring small bowel anastomosis revision: A case report. World J Gastrointest Surg 2023; 15:488-494. [PMID: 37032803 PMCID: PMC10080595 DOI: 10.4240/wjgs.v15.i3.488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 01/15/2023] [Accepted: 02/16/2023] [Indexed: 03/27/2023] Open
Abstract
BACKGROUND Xanthogranulomatous inflammation (XGI) is an uncommon process involving an accumulation of inflammatory cells, commonly lipid-laden macrophages. XGI has been described to occur throughout the body but only rarely in the lower gastrointestinal tract. We describe a case of XGI contributing to chronic obstructive symptoms in the terminal ileum, in which the patient had an initial diagnostic laparoscopy, continued to have symptoms, then proceeded to have the definitive treatment. To our knowledge, this is the first report of XGI associated with a prior small bowel anastomosis.
CASE SUMMARY We report the case of a 42-year-old female who presented with intermittent epigastric pain and subjective fevers. She had undergone a laparoscopic small bowel resection for Meckel’s diverticulum five years prior. Her workup was notable for computed tomography scan demonstrating mild inflammation and surrounding stranding at the level of the prior anastomosis. She underwent a laparotomy, resection of the prior anastomosis and re-anastomosis, with final histopathological examination findings consistent with mural XGI.
CONCLUSION XGI can occur at the site of a prior bowel anastomosis and cause chronic obstructive symptoms.
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Affiliation(s)
- William Wang
- Department of Biology, Stanford University, Stanford, CA 94305, United States
- Department of Bioengineering, Stanford University, Stanford, CA 94305, United States
| | - Maria Korah
- Division of General Surgery, Department of Surgery, Stanford University, Stanford, CA 94305, United States
| | - Kovi E Bessoff
- Division of General Surgery, Department of Surgery, Stanford University, Stanford, CA 94305, United States
| | - Jeanne Shen
- Center for Artificial Intelligence in Medicine and Imaging, Stanford University, Palo Alto, CA 94304, United States
- Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Joseph D Forrester
- Division of General Surgery, Department of Surgery, Stanford University, Stanford, CA 94305, United States
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Brillantino A, Sandoval Sotelo ML, Cricrì AM, Geraci A, Cricrì M, Scardi F, Monte G, Fusco F, Atelli PF, Antropoli M, Lanza M, Squillante S, Benassai G, Quarto G, Castriconi M. Hand-Sewn Versus Stapled Small Bowel Anastomoses in Patients With Secondary Mesenteric Ischemia. J Surg Res 2023; 281:52-56. [PMID: 36115149 DOI: 10.1016/j.jss.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 06/18/2022] [Accepted: 08/15/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Although stapled anastomoses have been widely evaluated in the context of the elective surgery, few reports compared manual with stapled anastomoses in patients undergoing emergency surgery. The aim of this study is to compare the outcome of hand-sewn end-to-end anastomoses with stapled side-to-side and stapled end-to-side anastomoses in patients undergoing small bowel resection for acute mesenteric ischemia secondary to intestinal obstruction. METHODS From January 2015 to June 2021 all the hemodynamically stable patients undergoing emergency surgery with small bowel resection for intestinal obstruction were enrolled in this study. According to surgical technique in performing anastomosis, the patients were divided into three groups: group 1: hand-sewn end-to-end anastomosis, group 2: stapled end-to-side anastomosis, and group 3: stapled side-to-side anastomosis. RESULTS Although the anastomosis failure rate was higher in group 3, it was not significantly different between the three groups (P = 0.78: chi-square test). Likewise, no significant differences in the median hospital stay were found between the patients' groups (P = 0.87: Kruskal-Wallis test). The median operating time was similar in patients undergoing stapled anastomoses and was significantly higher in patients undergoing hand-sewn anastomoses (P = 0.0009: Kruskal-Wallis test). CONCLUSIONS In patients undergoing emergency small bowel resection for complicated intestinal obstruction, a similar outcome in terms of dehiscence rate and hospital stay can be achieved performing stapled or hand-sewn anastomoses, even if restoring the intestinal continuity with stapled technique is associated with lower operating time.
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Affiliation(s)
| | | | | | - Antonella Geraci
- Emergency Surgery Department "A. Cardarelli" Hospital, Naples Italy
| | | | - Francesco Scardi
- Emergency Surgery Department "A. Cardarelli" Hospital, Naples Italy
| | - Giovanni Monte
- Emergency Surgery Department "A. Cardarelli" Hospital, Naples Italy
| | - Ferdinando Fusco
- Emergency Surgery Department "A. Cardarelli" Hospital, Naples Italy
| | | | | | - Michele Lanza
- Emergency Surgery Department "A. Cardarelli" Hospital, Naples Italy
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Geropoulos G, Psarras K, Giannis D, Martzivanou EC, Papaioannou M, Kakos CD, Pavlidis ET, Symeonidis N, Koliakos G, Pavlidis TE. Platelet rich plasma effectiveness in bowel anastomoses: A systematic review. World J Gastrointest Surg 2021; 13:1736-1753. [PMID: 35070077 PMCID: PMC8727194 DOI: 10.4240/wjgs.v13.i12.1736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/11/2021] [Accepted: 11/18/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Anastomotic leak constitutes a major problem in abdominal surgery. Technical insufficiency, topical or systemic factors contribute to disrupted healing of the performed bowel anastomosis and result in anastomosis leakage, with detrimental effects on patient postoperative outcomes. Despite the investigation of several factors and the invention of protective materials, the ideal agent to prevent anastomotic leaks is yet to be determined.
AIM To study the effect of platelet rich plasma (PRP) on the healing of bowel anastomoses.
METHODS A systematic literature search was performed in PubMed, EMBASE, and Scopus databases to identify studies investigating the effect of PRP application on bowel anastomosis.
RESULTS Eighteen studies were eligible with a total population of 712 animals including rats (14 studies), rabbits (2 studies) and pigs (2 studies). No postoperative complications were reported following PRP application. Fourteen out of 18 studies reported a statistically significant higher anastomosis bursting pressure in PRP groups compared to control either in healthy animals or animal models with underlying condition or intervention, such as intraperitoneal chemotherapy or peritonitis. Similar results were reported by ten studies in terms of tissue hydroxyproline levels. One study reported significant increase in collagen deposition in PRP groups. PRP application resulted in significantly decreased inflammatory cell infiltration in the presence of peritonitis or intraperitoneal chemotherapy (6 studies).
CONCLUSION The application of PRP is associated with improved bowel anastomosis outcomes, especially in animal models having an underlying condition affecting the normal healing process. PRP application seems to augment the normal healing process under these circumstances. However, further studies are needed to investigate the potential role of PRP on bowel anastomosis healing, especially in clinical settings.
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Affiliation(s)
- Georgios Geropoulos
- Department of General Surgery, University College London Hospitals, London NW1 2BU, United Kingdom
- Laboratory of Scientific Research and Experimental Surgery, 2nd Propedeutic Department of Surgery, School of Medicine, Aristotle University, Thessaloniki 54642, Greece
- Surgery Working Group, Society of Junior Doctors, Athens 15123, Greece
| | - Kyriakos Psarras
- Laboratory of Scientific Research and Experimental Surgery, 2nd Propedeutic Department of Surgery, School of Medicine, Aristotle University, Thessaloniki 54642, Greece
| | - Dimitrios Giannis
- Institute of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, NY 11030, United States
| | - Eirini Chrysovalantou Martzivanou
- Laboratory of Scientific Research and Experimental Surgery, 2nd Propedeutic Department of Surgery, School of Medicine, Aristotle University, Thessaloniki 54642, Greece
| | - Maria Papaioannou
- Laboratory of Biological Chemistry, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | | | - Efstathios Theodoros Pavlidis
- Laboratory of Scientific Research and Experimental Surgery, 2nd Propedeutic Department of Surgery, School of Medicine, Aristotle University, Thessaloniki 54642, Greece
| | - Nikolaos Symeonidis
- Laboratory of Scientific Research and Experimental Surgery, 2nd Propedeutic Department of Surgery, School of Medicine, Aristotle University, Thessaloniki 54642, Greece
| | - Georgios Koliakos
- Laboratory of Biological Chemistry, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Theodoros Efstathios Pavlidis
- Laboratory of Scientific Research and Experimental Surgery, 2nd Propedeutic Department of Surgery, School of Medicine, Aristotle University, Thessaloniki 54642, Greece
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Brillantino A, Lanza M, Antropoli M, Amendola A, Squillante S, Bottino V, Renzi A, Castriconi M. Usefulness of damage control approach in patients with limited acute mesenteric ischemia: a prospective study of 85 patients. Updates Surg 2021; 74:337-342. [PMID: 34686970 DOI: 10.1007/s13304-021-01192-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 10/10/2021] [Indexed: 02/03/2023]
Abstract
To evaluate the efficacy of the damage control approach by two-step surgical procedure in not critical patients (without sepsis or septic shock) with peritonitis from limited acute mesenteric ischemia. From April 2013 to April 2020, 85 patients [49 (57.7%) women and 36 (42.3%) men, median age 69.5 (range 38-92)] were enrolled in this study and underwent emergency surgery. After resection of ischemic bowel, basing on the individual decision of the single surgeon, the patients underwent primary end-to-end anastomosis (Group 1) or damage control approach (Group 2) including primary laparotomy with resection of ischemic bowel, temporary abdominal closure and a second-look procedure at 48 h with re-evaluation of bowel vitality. Forty-seven (55.3%) patients underwent one-stage surgical treatment and 38 (44.7%) patients received a two-step procedure. In the latter group, at second exploration, 8 (21%) patients required a further intestinal resection, due to mesenteric ischemia progression. Both anastomosis dehiscence rate and need for ileostomy in Group 1 patients were significantly higher than in Group 2 (23.4% vs 5.3%: p = 0.03 and 19.1% vs 2.6%: p = 0.03; Fisher's exact test). No significative differences in mortality and morbidity rate were found between the two groups. The damage control approach by two-step surgical procedure may represent a valid innovative option in the management of not critical patients with limited acute mesenteric ischemia, achieving a better clinical outcome if compared with surgical treatment by one-step procedure.
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Affiliation(s)
- Antonio Brillantino
- Department of Surgery, "A. Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy.
| | - Michele Lanza
- Department of Surgery, "A. Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
| | - Massimo Antropoli
- Department of Surgery, "A. Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
| | - Alfonso Amendola
- Department of Surgery, "A. Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
| | - Simone Squillante
- Department of Surgery, "A. Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
| | - Vincenzo Bottino
- Department of Surgery, "Villa Betania" Hospital, Via Argine 604, 80147, Naples, Italy
| | - Adolfo Renzi
- Department of Surgery, "Buonconsiglio Fatebenefratelli" Hospital, Via Alessandro Manzoni 220, 80123, Naples, Italy
| | - Maurizio Castriconi
- Department of Surgery, "A. Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
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Santos-Jasso KA, Lezama-Del Valle P, Arredondo-Garcia JL, García-De la Puente S, Martinez-Garcia MC. Efficacy and safety of an abbreviated perioperative care bundle versus standard perioperative care in children undergoing elective bowel anastomoses: A randomized, noninferiority trial. J Pediatr Surg 2020; 55:2042-2047. [PMID: 32063367 DOI: 10.1016/j.jpedsurg.2019.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/05/2019] [Accepted: 12/09/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE The aim was to evaluate if an abbreviated perioperative care bundle (APCB) is noninferior to the standard care, in terms of efficacy and safety, in pediatric patients undergoing bowel anastomoses. METHODS A randomized, open, noninferiority trial with two parallel groups of equal size was carried out at the National Institute of Pediatrics in Mexico City, Mexico, from April 2016 to July 2018. The total number analyzed was 74 (37 per group). The APCB comprised same day admission, avoidance of mechanical bowel preparation, optimized antibiotic prophylaxis, and early feeding. Statistical analysis was done with Fisher's exact test or Chi2, and Student's T test. RESULTS No significant differences were found for demographic variables and type of disease, either for the safety (anastomotic leakage, p 0.753; organ/space surgical site infection, p 0.500) or for some efficacy outcomes (ileus or bowel obstruction, p 0.693). Other efficacy outcomes were better in the study group, with shorter median times for feeding tolerance (19 h vs. 92 h, p < 0.001), for first bowel movement (15 h vs. 36 h, p < 0.001), and for discharge (1 vs. 6 days, p < 0.001). CONCLUSION The abbreviated care bundle was proven to be as safe but more efficacious than the standard care. LEVEL OF EVIDENCE I - randomized controlled trial with adequate statistical power.
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Affiliation(s)
- Karla A Santos-Jasso
- Department of General Pediatric Surgery, Instituto Nacional de Pediatria, Av Insurgentes Sur 3700-C, Colonia Insurgentes Cuicuilco, Alcaldia Coyoacan, Mexico City, Mexico 04530.
| | - Pablo Lezama-Del Valle
- Department of General Pediatric Surgery, Hospital Infantil de Mexico Federico Gomez, Mexico City, Mexico.
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2015 European Society of Coloproctology Collaborating Group. The impact of stapling technique and surgeon specialism on anastomotic failure after right-sided colorectal resection: an international multicentre, prospective audit. Colorectal Dis 2018; 20:1028-40. [PMID: 29920945 DOI: 10.1111/codi.14308] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 05/14/2018] [Indexed: 01/24/2023]
Abstract
AIM There is little evidence to support choice of technique and configuration for stapled anastomoses after right hemicolectomy and ileocaecal resection. This study aimed to determine the relationship between stapling technique and anastomotic failure. METHOD Any unit performing gastrointestinal surgery was invited to contribute data on consecutive adult patients undergoing right hemicolectomy or ileocolic resection to this prospective, observational, international, multicentre study. Patients undergoing stapled, side-to-side ileocolic anastomoses were identified and multilevel, multivariable logistic regression analyses were performed to explore factors associated with anastomotic leak. RESULTS One thousand three hundred and forty-seven patients were included from 200 centres in 32 countries. The overall anastomotic leak rate was 8.3%. Upon multivariate analysis there was no difference in leak rate with use of a cutting stapler for apical closure compared with a noncutting stapler (8.4% vs 8.0%, OR 0.91, 95% CI 0.54-1.53, P = 0.72). Oversewing of the apical staple line, whether in the cutting group (7.9% vs 9.7%, OR 0.87, 95% CI 0.52-1.46, P = 0.60) or noncutting group (8.9% vs 5.7%, OR 1.40, 95% CI 0.46-4.23, P = 0.55) also conferred no benefit in terms of reducing leak rates. Surgeons reporting to be general surgeons had a significantly higher leak rate than those reporting to be colorectal surgeons (12.1% vs 7.3%, OR 1.65, 95% CI 1.04-2.64, P = 0.04). CONCLUSION This study did not identify any difference in anastomotic leak rates according to the type of stapling device used to close the apical aspect. In addition, oversewing of the anastomotic staple lines appears to confer no benefit in terms of reducing leak rates. Although general surgeons operated on patients with more high-risk characteristics than colorectal surgeons, a higher leak rate for general surgeons which remained after risk adjustment needs further exploration.
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Rove KO, Brockel MA, Saltzman AF, Dönmez MI, Brodie KE, Chalmers DJ, Caldwell BT, Vemulakonda VM, Wilcox DT. Prospective study of enhanced recovery after surgery protocol in children undergoing reconstructive operations. J Pediatr Urol 2018; 14:252.e1-9. [PMID: 29398586 DOI: 10.1016/j.jpurol.2018.01.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 01/03/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) protocol is a set of peri-operative strategies to increase speed of recovery. ERAS is well established in adults but has not been well studied in children. OBJECTIVE The purpose of the current study was to establish the safety and efficacy of an ERAS protocol in pediatric urology patients undergoing reconstructive operations. It was hypothesized that ERAS would reduce length of stay and decrease complications when compared with historical controls. STUDY DESIGN Institutional Review Board approval was obtained to prospectively enroll patients aged <18 years if they had undergone urologic reconstruction that included a bowel anastomosis. ERAS included: no bowel preparation, administration of pre-operative oral carbohydrate liquid, avoidance of opioids, regional anesthesia, laparoscopy when feasible, no postoperative nasogastric tube, early feeding, and early removal of intravenous fluids (IVF). Recent (2009-2014) historical controls were propensity matched in a 2:1 ratio on age, sex, ventriculoperitoneal shunt status and whether the patient was undergoing bladder augmentation. Outcomes were protocol adherence, length of stay (LOS), emergency department (ED) visits, re-admission within 30 days, re-operations and adverse events occurring within 90 days of surgery. RESULTS A total of 26 historical and 13 ERAS patients were included. Median ages were 10.4 (IQR 8.0-12.4) and 9.9 years (IQR 9.1-11), respectively (P = 0.94) (see Summary Table). There were no significant between-group differences in prior abdominal surgery (38% vs 62%), rate of augmentation (88% vs 92%) or primary diagnosis of spina bifida (both 62%). ERAS significantly improved use of pre-operative liquid load (P < 0.001), avoidance of opioids (P = 0.046), early discontinuation of IVF (P < 0.001), and early feeding (P < 0.001). Protocol adherence improved from 8/16 (IQR 4-9) historically to 12/16 (IQR 11-12) after implementation of ERAS. LOS decreased from 8 days to 5.7 days (P = 0.520). Complications of any grade per patient decreased from 2.1 to 1.3 (OR 0.71, 95% CI 0.51-0.97). There were fewer complications per patient across all grades with ERAS. No differences were seen in emergency department (ED) visits, re-admissions and re-operations. DISCUSSION Implementation improved consistency of care delivered. Tenets of ERAS that appeared to drive improvements included maintenance of euvolemia through avoidance of excess fluids, multimodal analgesia, and early feeding. CONCLUSION ERAS decreased length of stay and 90-day complications after pediatric reconstructive surgery without increased re-admissions, re-operations or ED visits. A multicenter study will be required to confirm the potential benefits of adopting ERAS.
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Abstract
INTRODUCTION Despite advances in oncological outcomes in colo-rectal surgery, rates of anastomotic leak have not improved. The precise mechanisms of anastomotic leak remain poorly understood. Current research has focused on anastomotic reinforcement to tackle anastomotic leak with little success. The 'Angle of Sorrow', the corner of the anastomosis is prone to anastomotic leak, but remains a persistent feature in the gastrointestinal anastomosis. The tendency for stress forces to concentrate in the vulnerable 'Angle of Sorrow' prompts the need for anastomotic design research. AIM The aim of this study is to explore if redesigning the 'Angle of Sorrow' can reduce the stress forces in the ileocolic anastomosis. METHODS A simulation-based experimental study compared two anastomotic designs: traditional Slit Enterotomy Anastomosis (SEA) vs a novel Radiused Enterotomy Anastomosis (REA). The finite element analysis simulations were performed using FEBIO to measure peak sheer stress in pressurised bowel. RESULTS Tissue stress was found to concentrate at the 'Angles of Sorrow' in traditional anastomosis design while the REA design distributed sheer stress across the anastomosis. The SEA model had greater peak sheer stress factors than REA for the hand-sewn and stapled 'Barcelona' anastomosis (1.58 (k) vs 0.64 (k), 0.91 (k) vs 0.63 (k)). The REA anastomosis resulted in significantly less peak stress across all anastomotic experiments (p = 0.0047). The mucosa of the SEA model tended to unfavourably evert. CONCLUSION Redesigning the 'Angle of Sorrow' decreased tissue stress concentration. The direction of future anastomotic research may involve going back to the drawing board, rather than attempting to reinforce a potentially flawed design. Despite advances in colorectal surgery, rates of anastomotic leak have not improved. The 'Angle of Sorrow', the corner of the anastomosis is prone to anastomotic leak, but remains a persistent feature in gastrointestinal anastomosis. The direction of future research may involve going back to redesign this vulnerable area.
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Affiliation(s)
- Omar E Aly
- Raigmore Hospital-Inverness, Old Perth Rd, Inverness, Scotland, IV2 3UJ, UK.
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Kar S, Mohapatra V, Singh S, Rath PK, Behera TR. Single Layered Versus Double Layered Intestinal Anastomosis: A Randomized Controlled Trial. J Clin Diagn Res 2017; 11:PC01-PC04. [PMID: 28764239 DOI: 10.7860/jcdr/2017/24817.9983] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 01/09/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Gastrointestinal anastomosis is one of the most common procedures being performed in oesophagogastric, hepatobiliary, bariatric, small bowel and colorectal surgery; however, the safety and efficacy of single layer or double layer anastomotic technique is still unclear. AIM To assess and compare the efficacy, safety and cost effectiveness of single layered versus double layered intestinal anastomosis. MATERIALS AND METHODS This prospective, double-blind, randomized controlled comparative study comprised of patients who underwent intestinal resection and anastomosis. They were randomly assigned to undergo either single layered extra-mucosal anastomosis (Group-A) or double layered intestinal anastomosis (Group-B). Primary outcome measures included average time taken for anastomosis, postoperative complications, mean duration of hospital stay and cost of suture material used; secondary outcome measures assessed the postoperative return of bowel function. Statistical analysis was done by Chi-square test and student t-test. RESULTS A total of 97 participants were randomized. Fifty patients were allocated to single layered extramucosal continuous anastomosis (Group-A) and 47 patients to double layered anastomosis (Group-B). The patients in each group were well matched for age, sex and diagnosis. The mean time taken for anastomosis (15.12±2.27 minutes in Group-A versus 24.38±2.26 minutes in Group-B) and the length of hospital stay (5.90±1.43 days in Group-A versus 7.29±1.89 days in Group-B) was significantly shorter in Group-A {p-value <0.001}. The postoperative return of bowel function was quicker in the single layer group (2.42±1.11 days) as compared to the double layer group (3.1±1.34 days). The cost of suture material used was relatively more in the single layered group (564 INR vs. 480 INR) which might be the only factor favoring a double layered anastomosis. However, there was no significant difference in the complication rates between the two groups. CONCLUSION It can be concluded that single layered extramucosal continuous intestinal anastomosis is equally safe and perhaps more cost effective than the conventional double layered method and may represent the optimal choice for routine surgical practice.
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Affiliation(s)
- Sibabrata Kar
- Assistant Professor, Department of General Surgery, Shri Ramachandra Bhanj (S.C.B) Medical College, Cuttack, Odisha, India
| | - Vandana Mohapatra
- Senior Resident, Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
| | - Surendra Singh
- Postgraduate Student, Department of General Surgery, Shri Ramachandra Bhanj (S.C.B) Medical College, Cuttack, Odisha, India
| | - Pratap Kumar Rath
- Professor, Department of General Surgery, Shri Ramachandra Bhanj (S.C.B) Medical College, Cuttack, Odisha, India
| | - Tapas Ranjan Behera
- Assistant Professor, Department of Community Medicine, Shri Ramachandra Bhanj (S.C.B) Medical College, Cuttack, Odisha, India
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Kern NG, Behrens AM, Srinivasan P, Rossi CT, Daristotle JL, Kofinas P, Sandler AD. Solution blow spun polymer: A novel preclinical surgical sealant for bowel anastomoses. J Pediatr Surg 2017; 52:1308-1312. [PMID: 27956071 PMCID: PMC5459684 DOI: 10.1016/j.jpedsurg.2016.11.044] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 11/15/2016] [Accepted: 11/28/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Solution blow spinning is a technique for depositing polymer fibers with promising potential use as a surgical sealant. This study assessed the feasibility and efficacy of solution blow spun polymer (BSP) for sealing bowel perforations in a mouse model of partial cecal transection. We then evaluated its use for reinforcing a surgical anastomosis in a preclinical piglet model. METHODS Three commercially available surgical sealants (fibrin glue, polyethylene glycol (PEG) hydrogel, and cyanoacrylate) were compared to BSP in the ability to seal partially transected cecum in mice. For anastomosis feasibility testing in a piglet model, piglets were subjected to small bowel transection with sutured anastomosis reinforced with BSP application. Outcome measures included anastomotic burst pressure, anastomotic leak rate, 14-day survival, and complication rate. RESULTS For the mouse model, the survival rates for the sealants were 30% for fibrin glue, 20% for PEG hydrogel, 78% for cyanoacrylate, and 67% for BSP. Three of 9 mice died after BSP administration because of perforation leak, failure to thrive with partial obstruction at the perforation site, and unknown causes. All other mice died of perforation leak. The mean burst pressure at 24h was significantly higher for BSP (81mm Hg) when compared to fibrin glue (6mm Hg, p=0.047) or PEG hydrogel (10mm Hg, p=0.047), and comparable to cyanoacrylate (64mm Hg, p=0.91). For piglets, 4 of 4 animals survived at 14days. Mean burst pressures at time of surgery were 37±5mm Hg for BSP and 11±9mm Hg for suture-only controls (p=0.09). CONCLUSIONS Solution blow spinning may be an effective technique as an adjunct for sealing of gastrointestinal anastomosis. Further preclinical testing is warranted to better understand BSP properties and alternative surgical applications.
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Affiliation(s)
- Nora G Kern
- Sheikh Zayed Institute for Pediatric Surgical Innovation at Children's National Health System, 111 Michigan Ave. NW, Washington, DC 20010, USA; Department of Urology, University of Virginia Health System, PO Box 800422, Charlottesville, VA 22908, USA.
| | - Adam M Behrens
- Fischell Department of Bioengineering, University of Maryland, 8228 Paint Branch Dr., College Park, MD 20742, USA
| | - Priya Srinivasan
- Sheikh Zayed Institute for Pediatric Surgical Innovation at Children's National Health System, 111 Michigan Ave. NW, Washington, DC 20010, USA
| | - Christopher T Rossi
- Department of Pathology, Children's National Health System, 111 Michigan Ave. NW, Washington, DC 20010, USA
| | - John L Daristotle
- Fischell Department of Bioengineering, University of Maryland, 8228 Paint Branch Dr., College Park, MD 20742, USA
| | - Peter Kofinas
- Fischell Department of Bioengineering, University of Maryland, 8228 Paint Branch Dr., College Park, MD 20742, USA
| | - Anthony D Sandler
- Sheikh Zayed Institute for Pediatric Surgical Innovation at Children's National Health System, 111 Michigan Ave. NW, Washington, DC 20010, USA
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Bobkiewicz A, Studniarek A, Krokowicz L, Szmyt K, Borejsza-Wysocki M, Szmeja J, Marciniak R, Drews M, Banasiewicz T. Gastrointestinal tract anastomoses with the biofragmentable anastomosis ring: is it still a valid technique for bowel anastomosis? Analysis of 203 cases and review of the literature. Int J Colorectal Dis 2017; 32:107-111. [PMID: 27695974 PMCID: PMC5219882 DOI: 10.1007/s00384-016-2661-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE Biofragmentable anastomosis ring (BAR) is an alternative to manual and stapled anastomoses performed within the upper and lower gastrointestinal (GI) tract. The aim of this study was to evaluate the effectiveness of BAR utility for bowel anastomoses based on our own material. METHODS A retrospective analysis was performed to a total of 203 patients who underwent bowel surgery with the use of BAR anastomosis within upper and lower gastrointestinal tract between 2004 and 2014. Data for the analysis was collected based on medical records, treatment protocols, and the results of histological examinations. RESULTS The study group consisted of 86 women and 117 men. The most common underlying pathology was a malignant disease (n = 165). Biofragmentable anastomosis ring (BAR) size 31 was the most commonly used (n = 87). A total of 169 colocolic or colorectal anastomoses and 28 ileocolic and 8 enteroenteric anastomoses were performed. The mortality rate was 0.5 % (n = 1) whereas re-surgery rate within 30 days was 8.4 % (n = 17). Twenty-eight patients developed perioperative complications with surgical site infection as the most common one (n = 11). Eight patients developed specific complications associated with BAR including an anastomotic leak (n = 6) and intestinal obstruction (n = 2). The mean time of hospital stay after surgery was 12.7 days. CONCLUSIONS The use of BAR for the GI tract anastomoses is simple and rapid method and it is characterized with an acceptable number of perioperative mortality and complication rates. Based on our experience, we recommend the use of BAR anastomosis in different types of intestinal anastomosis in varying clinical scenarios.
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Affiliation(s)
- Adam Bobkiewicz
- Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-355, Poznan, Poland.
| | - Adam Studniarek
- Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-355, Poznan, Poland
| | - Lukasz Krokowicz
- Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-355, Poznan, Poland
| | - Krzysztof Szmyt
- Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-355, Poznan, Poland
| | - Maciej Borejsza-Wysocki
- Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-355, Poznan, Poland
| | - Jacek Szmeja
- Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-355, Poznan, Poland
| | - Ryszard Marciniak
- Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-355, Poznan, Poland
| | - Michal Drews
- Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-355, Poznan, Poland
| | - Tomasz Banasiewicz
- Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-355, Poznan, Poland
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Abstract
INTRODUCTION The Barcelona technique for bowel anastomosis is not well described in the currently available literature, but it saves steps when compared to conventional stapled anastomoses. In short, the proximal and distal ends of a resection margin are approximated, small enterotomies made, a stapler is passed into both lumens creating a common channel, and lastly, this same stapler is used to create the anastomosis and amputate the specimen. We report on this technique with ileostomy reversal in terms of cost and complications. MATERIALS AND METHODS Review of ileostomy reversals (2006-2014) by a single surgical oncologist. RESULTS Thirty patients had surgery using the Barcelona technique. Median age was 58 years, and median postoperative surgical stay was 3 days. The majority of patients had rectal cancer initially treated with low anterior resection and diverting loop ileostomy (80 %). One patient had a wound infection (3 %), and there were no anastomotic leaks, intra-abdominal abscesses, or strictures. This technique required fewer stapler loads saving $510 in charges per case. CONCLUSIONS The Barcelona technique is safe and effective for ileostomy reversal. There are reduced costs related to equipment as compared to the conventional technique and thus the use of this method can result in significant medical cost savings.
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Affiliation(s)
- Katie W Russell
- Department of Surgery, School of Medicine, University of Utah, 30 North 1900 East, 3B 110, Salt Lake City, UT, 84132, USA
| | - Brigid P O'Holleran
- Department of Surgery, School of Medicine, University of Utah, 30 North 1900 East, 3B 110, Salt Lake City, UT, 84132, USA
| | - Megan E Bowen
- Department of Surgery, School of Medicine, University of Utah, 30 North 1900 East, 3B 110, Salt Lake City, UT, 84132, USA
| | - Mary C Mone
- Department of Surgery, School of Medicine, University of Utah, 30 North 1900 East, 3B 110, Salt Lake City, UT, 84132, USA
| | - Courtney L Scaife
- Department of Surgery, School of Medicine, University of Utah, 30 North 1900 East, 3B 110, Salt Lake City, UT, 84132, USA.
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