Open Anastomosis Research Articles

Tubular gastric elongation surgery for high esophageal-gastric anastomosis after resection of esophageal cancer: analysis of 5 cases

To summarize our experience with tubular gastric elongation surgery for management of insufficient gastric length for high esophageal-gastric anastomosis following esophageal carcinoma resection. From September, 2015 to October 2016, 5 patients with esophageal cancer were treated in our department, including two with cervical esophageal cancer and 3 with thoracic esophageal cancer. The patients with cervical esophageal cancer underwent pharyngeal resection, total laryngectomy, esophageal varus extubation and gastric oropharyngeal anastomosis, and the patients with thoracic esophageal cancer underwent esophageal cancer resection with incisions on the left neck, the right chest and the median abdomen. During the surgery, the length of the stomach was found insufficient to allow routine oropharyngeal anastomosis, and tubular gastric elongation was conducted to extend the tubular stomach to enable successful completion of the surgery. All the patients recovered smoothly after the surgery and were discharged after 2-3 weeks. Tubular gastric elongation surgery can be a good choice for high esophageal-gastric anastomosis after resection of esophageal cancer in cases of insufficient tubular stomach length or high tension at the anastomosis.

Patchy colitis, and young age at diagnosis and at the time of surgery predict subsequent development of Crohn's disease after ileal pouch-anal anastomosis surgery for ulcerative colitis.

Background and AimA proportion of patients having total proctocolectomy and ileal pouch‐anal anastomosis (IPAA) for ulcerative colitis (UC) are later diagnosed with Crohn's disease (CD). The aim of this study was to identify preoperative and perioperative predictors for the subsequent development of CD in patients who had IPAA for presumed UC.MethodsA retrospective case–control study of patients undergoing IPAA surgery for presumed UC was undertaken. Cases were patients who had a revised diagnosis of CD after surgery. Preoperative and perioperative variables were examined and analyzed.ResultsFifteen cases were compared with 39 controls. Patients aged ≤25 years at initial UC diagnosis were more likely to develop CD compared to those aged >25 years (odds ratio, OR [95% confidence interval, CI]: 7.1 [1.6–31.3]; P = 0.01). Patients aged ≤30 years at the time of colectomy had an increased risk of subsequent development of CD compared to those aged >30 years (OR [95% CI]: 4.5 [1.3–16.0]; P = 0.02). Cases were more likely to have patchy colitis on their colectomy specimen (OR [95% CI]: 6.7 [1.1–41.8]; P = 0.04). There was no significant difference between groups regarding transmural inflammation, ileitis, or fissuring ulcers on colectomy specimens, or preoperative C‐reactive protein (CRP), albumin, family history, and smoking status.ConclusionPredictors of the development of CD in the pouch include young age at diagnosis and at the time of surgery, and patchy colitis in the resected colon.

Análisis de variables relacionadas con la morbimortalidad de la anastomosis ileocólica después de hemicolectomía derecha

Introduction: Right hemicolectomy with ileocolic anastomosis is a frequent surgery with many ways to perform it. Objective: To evaluate which is the best ileocolic anastomosis in terms of morbidity and mortality and to make a comparative evaluation of the postoperative clinical evolution according to the type of anastomosis. Patients and Method: Analytical observational study, with defined inclusion and exclusion criteria. The variables to be studied are divided into two groups, those related to the surgical technique and its anastomotic configuration, and the variables related to the results of the surgical intervention, creating a contingency table that crosses the data. Data analysis with STATA 13.0. Results: 216 patients with ileocolic anastomosis, highlighting statistical significance when crossing: A) reoperation and type of suture (p = 0.044), with UN or 3.4 (95% CI 0.94 to 18.6), being of greater risk the mechanics; B) mortality and urgency (p = 0.001) with an OR 7.76 (95% CI 1.56-49.29), with emergency surgery being of greater risk. Isoperistaltic anastomosis with gas elimination (p < 0.001), intestinal transit (p = 0.009) and solid intake (p = 0.005) earlier. There is earlier expulsion of gases in the laparoscopic approach, manual suture, end-to-side and isoperistaltic of the anastomosis and elective surgery. Conclusion: There is great variability of techniques to perform the ileocolic anastomosis. Manual anastomosis is less likely to require surgical reoperation, elective surgery has a lower mortality than that of emergency surgery. We suggest performing it laparoscopically, with manual suture, lateral term, isoperistaltic and electively, for having a shorter recovery.

The effect of a concomitant renal injury on the outcome of colonic trauma

BackgroundThe management of colon injuries has steadily evolved over the course of the last half century. So too has the management of renal trauma. It is not clear from the literature as to whether concomitant colon and renal injuries carry increased risk of morbidity and mortality, and whether this combination of injuries necessitates a specifically tailored management approach. MethodsA retrospective review was carried out for the period January 2012 to December 2016. All patients over the age of 18 years who were subjected to laparotomy for penetrating trauma (gunshot wounds or stab wounds) and who sustained an intra-operatively proven colonic injury were included in this study. Operative management and outcomes were investigated. A direct comparison was made between patients with a combined colonic and renal injury and those with only a colonic injury. ResultsOver the five-year period a total of 268 patients sustained a colonic injury. The 239 patients with a colonic injury (Group A) were compared to the 29 patients with a combined colonic and renal injury (Group B). Regarding the management of the colonic injuries, there were no differences in the rates of primary repair, anastomosis, exteriorization, or damage control surgery between groups A and B. As for the management of the renal injury, 14 were not explored at laparotomy; in 12 a nephrectomy was performed and in 3 the renal injury was repaired. The nephrectomy cohort were more likely to have undergone damage control surgery, to be admitted to ICU, to receive a colostomy, and had higher mortality. While there was no difference in the need for damage control surgery or mortality between groups, Group B had a significantly greater need for ICU admission. Morbidity was similar between the two groups – in particular, there was no difference in the rates of either gastro-intestinal complications or acute kidney injury between the two groups. ConclusionIn patients with combined colon and renal injuries, it seems reasonable to treat each organ on its own merit, without the expectation of increased morbidity or mortality. In the non-damage control setting, most colonic injuries may be safely repaired, and a peri-renal haematoma that is not expanding or actively bleeding may be safely left alone.

Laparoscopic versus open colectomy for obstructing right colon cancer: A systematic review and meta-analysis

Hemicolectomy is the treatment of choice for intestinal obstruction from right colon cancer. This review compares the laparoscopic vs open access in hemicolectomy for patients with right colon cancer. A systematic review and meta-analysis of clinical studies published after January2017 was performed according to the Prisma guidelines. The study has been recorded on the Prospero register (CRD42016044108). Five studies were included for review. Only one anastomotic leak was reported in conventional open anastomosis group (1.9%) and none of the studies included in the meta-analysis reported re-operations during the first 30postoperative days. The 30-day postoperative mortality did not differ between the two groups. The length of incision, blood loss, early mobilization after surgery, the 30-day postoperative overall complication rate and hospital length of stay were significantly shorter in the laparoscopic group. The difference in the duration of procedure was statistically significant in favor of the open group. The number of dissected lymph nodes, the overall survival at 5years and time to flatus were described only in one study, without any significant difference. Finally, none of the trials reported any information concerning differences in the costs between the two techniques. The better outcomes described in this study achieved with laparoscopy, must be interpreted with caution because of the small number of patients involved, the selection and publication bias and the low level of evidence of the analysed trials. Indeed, the advantages of a minimally invasive approach, which have been demonstrated by the present meta-analysis, should encourage the use of laparoscopy also in emergency setting.

Choices of methods in dividing the neck of pancreas in laparoscopic pancreaticoduodenectomy

Objective: To discuss the methods, skills and experiences of dividing the neck of pancreas in laparoscopic pancreaticoduodenectomy(LPD). Methods: The clinical data of 58 patients with periampullary tumors who received LPD at the Union Hospital of Fujian Medical University from December 2014 to January 2017 were retrospectively analyzed.There were 26 males and 32 females, ranged from 18 to 65 years, with a mean age of (46±12)years. Results: All of the 58 patients underwent operation smoothly.Three cases underwent open anastomosis via an auxiliary incision after the total resection of specimen laparoscopically, due to the early learning curve of LPD.Two cases transformed into open operation as a result of tumor vascular invasion to portal vein(PV) or superior mesenteric vein(SMV). Fifty-three cases underwent laparoscopic or laparoscopic combined with robotic pancreaticoduodenectomy completely.Forty-two cases ligated gastroduodenal artery(GDA), fully penetrated the interspace between rear of pancreatic neck and SMV, suspended the pancreas and then divided the neck of pancreas from inferior to superior. Thirteen cases fully dissected the interspace between rear of pancreatic neck and SMV, divided the neck of pancreas from inferior to superior and then ligated GDA.Three cases ligated GDA, dissected PV and SMV at the superior and inferior margin of the neck of pancreas separately, and then divided pancreas from anterior to posterior.Mean time of dividing pancreas was (34.9±9.7)minutes, mean volume of blood loss while dividing pancreas was (30.1±8.2)ml.The main postoperative complications included pancreatic fistula(7 cases, Biochemical leak 2 cases, B grade 3 cases, C grade 2 cases), biliary fistula(3 cases), gastric fistula(1 case), delayed gastric emptying(1 case, C grade), abdominal infection(5 cases), hepatic failure (1 case), intra-abdominal hemorrhage(2 cases), reoperation(2 cases). One case died at the perioperative period while others recovered.The mean duration of postoperative stay was (14.2±5.1)days. Conclusions: Dividing the neck of pancreas is one of the most important steps in LPD, which deserved sufficient attention.At the meantime, a suitable method of dividing the neck of pancreas should be chosen according to intraoperative exploration and preoperative imageological examinations.

Enteral feeding with low-methoxyl pectin accelerates colonic anastomosis healing in rats

Enteral feeding with pectin has proven beneficial for anastomosis healing in rats. The aim of this study was to investigate the effects of low-methoxyl pectin (LMP) or high-methoxyl pectin (HMP), on colonic anastomosis healing in rats. Male Sprague-Dawley rats (age 7wk) were fed liquid diets containing LMP, HMP, or no pectin (pectin-free [PF]) for 14d (n=10/group). The rats underwent colonic anastomosis surgery on day 7 and were sacrificed on day 14. Bursting pressure, breaking strength, and salt-soluble hydroxyproline at the anastomosis site were used as indices of anastomosis healing. Short-chain fatty acids (SCFAs) in the cecal contents were analyzed. Breaking strength was higher in the LMP group than in the other two groups (P<0.001). The salt-soluble hydroxyproline content was higher in LMP group than in the PF group (P<0.01). Bursting pressure did not differ among the three groups. The LMP group produced normal, formed stools, whereas watery stools were observed in HMP and PF groups throughout the experimental period. Cecal SCFAs were highest in LMP group. These results suggest that LMP promotes healing of colonic anastomosis more effectively than HMP, which may be explained by the mechanical stresses generated by the movement of normally formed stool though the colon.

Paradoxical Impact of Ileal Pouch-Anal Anastomosis on Male and Female Fertility in Patients With Ulcerative Colitis

Birth rates in males with ulcerative colitis and ileal pouch-anal anastomosis have not been studied. This study aimed to estimate birth rates in males and females with ulcerative colitis and study the impact of ileal pouch-anal anastomosis. This was a retrospective registry-based cohort study that was performed over a 30-year period. Records for parenting a child from the same period were cross-linked with patient records, and birth rates were calculated using 15 through 49 years as age limits. All data were prospectively registered. All patients with ulcerative colitis and ulcerative colitis with ileal pouch-anal anastomosis between 1980 and 2010 were identified in Danish national databases. The primary outcomes measured were birth rates in females and males with ulcerative colitis and ulcerative colitis with ileal pouch-anal anastomosis. We included 27,379 patients with ulcerative colitis (12,812 males and 14,567 females); 1544 had ileal pouch-anal anastomosis (792 males and 752 females). Patients with ulcerative colitis have slightly reduced birth rates (males at 40.8 children/1000 years, background population 43.2, females at 46.2 children/1000 years, background population 49.1). After ileal pouch-anal anastomosis, males had increased birth rates at 47.8 children/1000 years in comparison with males with ulcerative colitis without ileal pouch-anal anastomosis (40.5 children/1000 years), whereas females had reduced birth rates at 27.6 children/1000 years in comparison with females with ulcerative colitis without ileal pouch-anal anastomosis (46.8 children/1000 years). Only birth rates were investigated and not fecundability. Furthermore, there is a question about misattributed paternity, but this has previously been shown to be less than 5%. Ulcerative colitis per se has little impact on birth rates in both sexes, but ileal pouch-anal anastomosis surgery leads to a reduction in birth rates in females and an increase in birth rates in males. This has clinical impact when counseling patients before ileal pouch-anal anastomosis surgery.

Incidence, prevalence, and risk factors for pouchitis

Pouchitis is a complication of restorative proctocolectomy and ileal pouch-anal anastomosis surgery in patients who undergo the procedure for the treatment of inflammatory bowel disease or familial adenomatous polyposis. Patients can present with increased stool frequency, urgency, fecal seepage, and abdominal cramps. The reported cumulative frequency rates of pouchitis 10 years after IPAA surgery range from 23% to 60% in IBD patients and 0% to 11% in FAP patients. Although the pathogenesis of pouchitis is unclear, several risk factors for pouchitis have been identified including extraintestinal manifestations of inflammatory bowel disease, autoimmune disorder(s), severity of disease, serologic markers (serum IgG4, autoantibodies to bacterial antigens, p-ANCA, and anti-CBir1 flagellin antibody), genetic markers (NOD2 mutation), smoking, and certain dietary factors. In this review, we will focus on the incidence, prevalence, and risk factors associated with pouchitis.

Giant perforated marginal ulcer after laparoscopic Roux-en-Y gastric bypass

Perforation of a marginal ulcer (MU) is a complication of Roux-en-Y gastric bypass that can be life-threatening. We report a case of a perforated MU that presented 7 months after...

Signal reduction of donor artery on MRI after superficial temporal artery to middle cerebral artery anastomosis: a retrospective analysis.

Microsurgical anastomosis from the superficial temporal artery (STA) to the middle cerebral artery (MCA) is a treatment option for appropriately selected patients with cranial atherosclerotic steno-occlusive disease (CASD). However, the long-term efficacy and patency of the donor artery remain unclear. We reviewed the signal intensity of the donor artery on magnetic resonance angiography (MRA) after STA-MCA anastomosis in patients with CASD and clarified the incidence of and risk factors for reduction in postoperative signal of STA. From April 2007 to March 2015, 155 STA-MCA anastomosis operations for CASD were performed at our institute. The postoperative imaging findings of 112 patients with available follow-up data for more than 3months were retrospectively reviewed. Over a median follow-up of 24months, the signal of the donor artery on MRA became weaker than that on MRA performed immediately after surgery in 30 (27%) patients. The rates of signal reduction at 1 and 2years after surgery were 18 and 25%, respectively. Multivariate analysis revealed that a high STA bifurcation (p = 0.015; odds ratio, 7.14) and the presence of chronic kidney disease (p = 0.011; odds ratio, 5.59) were independent risk factors for postoperative signal reduction. Our results suggest that the signal intensity of the donor artery of an established STA-MCA bypass decreases in many cases. Both the loose entrance of the STA to the dura and systemic atherosclerosis are related to postoperative vessel remodeling.

Design and development of a hybrid bioartificial water-induced shape memory polymeric material as an integral component for the anastomosis of human hollow organs

A large number of pathologies require the resection of the bowel and anastomoses to rejoin the two remaining stumps to regain lumen patency. Various materials have been used to rejoin one bowel end to the other such as catgut, stainless steel, and absorbable sutures. The present method for anastomosis surgery uses an entero-entero anastomosis (EEA) circular stapler with only a staple line. This method can have some drawbacks, such as intracellular fluid leakage and local inflammations. The aim of this study is to design and develop a novel bioartificial polymer with a ring shape made of polyvinyl alcohol (PVA) and gelatin (80/20 ratio (w/w)) loaded both directly with acetylsalicylic acid and with nanoparticles incorporating the same drug to reduce local inflammation even for a prolonged period of time. A physical method (8cycles freezing/thawing) was used to obtain a crosslinked bioartificial shape memory ring.Mechanical analysis showed a storage modulus having a comparable value with that of the human colon. HPLC analysis pointed out a sustained and prolonged release of the anti-inflammatory drug both immediately after anastomosis surgery and during healing period. Cell culture tests indicated the cytocompatibility of the bioartificial device. A shape memory of the hydrogel prepared in ring form was observed at 37°C after immersion in water. These bioartificial devices can represent a new approach to serve as a multifunctional anastomotic ring.

A comparative study of in vitro contractility between gut tissues of Hirschsprung's disease and other gut malformations

Background: Hirschsprung’s disease and other gut malformations commonly present with obstructive features of gut in pediatric age group. Problem of obstruction persists even after resection and anastomosis operation. Aims and Objectives: This in vitro comparative study was performed to assess the gut contractility to chemical mediators such as Acetylcholine and Histamine between Hirschsprung’s disease and other gut malformations. Materials and Methods: The longitudinal muscle strips of Hirschsprung’s cases and other gut malformations (non-Hirschsprung’s cases) were placed in Dales organ bath containing Krebs-Ringer solution, continuously bobbled with 100% O2 at 28°C. Gut contractions were recorded using Power Lab 4/ST system and was analyzed using software CHART-5 for windows. Control contractions were recorded against initial tension of 0.5 g. Subsequently, agonist (acetylcholine, histamine)-induced contractions were recorded before and after appropriate antagonists (atropine, pheniramine). Before values of agonist-induced contractions of Hirschsprung and non-Hirschsprung’s cases were compared. Values of agonistinduced contractions obtained after pretreatment with antagonists were also compared between Hirschsprung and non- Hirschsprung’s cases. Results: Acetylcholine enhanced contractions in non-Hirschsprung’s cases and it caused small increase in amplitude of contractions in Hirschsprung’s cases. Atropine pretreatment blocked acetylcholine-induced contractions significantly in non-Hirschsprung’s cases, whereas it failed to block in the Hirschsprung’s cases. Histamine augmented contractions in both Hirschsprung and non-Hirschsprung’s cases. H1 antagonist, pheniramine failed to block the contractility in both the cases. Conclusion: Findings of this study suggested that acetylcholine increased gut contractility significantly in non-Hirschsprung’s cases involving muscarinic-cholinergic pathways, whereas histamine increased gut contractility in both Hirschsprung’s disease and non-Hirschsprung’s cases and it is not mediated by H1 receptors.

Intestinal Ganglioneuromatosis with Peri-intestinal Neurofibroma Limited to the Gastrointestinal Tract Clinically and Morphologically Mimicking Crohns Disease

Ganglioneuroma is a benign neurogenic tumor composed of ganglion cells, nerve fibers, and supporting cells. Intestinal ganglioneuromas are rare tumors more often identified in the adults as solitary polypoid ganglioneuromas, ganglioneuromatous polyposis and diffuse ganglioneuromatosis, presenting with abdominal pain, diarrhea, thickening of the bowel wall, and stricture formation. Diffuse ganglioneuromatosis is typically associated with multiple endocrine neoplasia, neurofibromatosis Type 1 and Cowden syndrome. In this case report, we describe a case of diffuse and polypoid ganglioneuromatosis along with peri-intestinal neurofibroma in a 30-year-old female with no syndromic afflictions. A 30-year-old female was investigated for recurrent alternating episodes of constipation and diarrhea since 15 days, associated with abdominal distension and palpable mass per abdomen. On contrast enhanced computed tomography abdomen and pelvis, multifocal strictures with subacute intestinal obstruction was noted with possibilities of Crohn’s disease or tuberculosis. Surgically resected terminal ileum and ascending colon had multiple linear ulcers, pseudopolyps, and cobblestone appearance. On histopathological examination of the resected specimen, diagnosis of intestinal ganglioneuromatosis (polypoid and diffuse) with suture granuloma and peri-intestinal neurofibroma was given. History elicited for similar prior complaints showed nonspecific ileocolitis on biopsy 2 years earlier. She also gave history of surgery for resection and anastomosis 6 years back. We report a patient with intestinal ganglioneuromatosis in whom clinical and radiological findings mimicked those of Crohn’s disease/tuberculosis. Despite its rarity, intestinal ganglioneuromatosis should be considered in patients with features suggestive of Crohn’s disease/tuberculosis on radiological investigations who have nonspecific mucosal biopsy findings and intractable symptoms despite medical treatment. Ganglioneuroma is a benign neurogenic tumor composed of ganglion cells, nerve fibers and supporting cells. In this case report, we describe a case of 30-year-old female with diffuse and polypoid ganglioneuromatosis along with peri-intestinal neurofibroma with no syndromic afflictions in whom clinical and radiological findings mimicked those of Crohn’s disease/tuberculosis. Despite its rarity, intestinal ganglioneuromatosis should be considered in patients with features suggestive of Crohn’s disease/tuberculosis.

Sustained-released mixture of vascular endothelial growth factor 165 and fibrin glue strengthens healing of ileal anastomoses in a rabbit model with intraperitoneal infection.

PurposeTo investigate the effects of a sustained-released mixture of vascular endothelial growth factor 165 (VEGF165) and fibrin glue (FG) local administration on postoperative rabbit ileal anastomoses.MethodsOne hundred twenty-eight male and female New Zealand white rabbits underwent intraperitoneal infection subsequent ileal anastomosis surgery were divided randomly into 4 groups, including 32 animals in each, applied with saline solution, FG, rhVEGF165 and a mixture of rhVEGF165 with FG (VEGF + FG) on the anastomoses, respectively. The incidences of anastomotic leakage were observed. Histopathological examination for inflammatory infiltration, fibroblast proliferation, and capillary vascular proliferation were performed. Then, bursting pressure and hydroxyproline concentrations were assessed in anastomoses sits on postoperative days 3, 5, 7, and 14.ResultsRabbits in VEGF + FG group had the lowest incidence of leakage (P < 0.05). Histological evaluations revealed that granulation tissue was formed on days 5 after anastomosis; fibroblast proliferation and capillary vascular proliferation were significantly increased on days 7 and 14 in VEGF + FG group. Furthermore, there was a statistically significant difference in the mean bursting pressures between VEGF + FG group and other groups on days 7 and 14 (P < 0.05), and rabbits in VEGF + FG group exhibited a higher concentration than VEGF group (P < 0.05) and FG group (P < 0.05) on day 14.ConclusionAdministration of VEGF165 mixed with FG to ileal anastomosis accelerates wound healing and enhances the anastomosis by increased angiogenesis.

FIRST EXPERIENCE OF THE URETERO-URETEROANASTOMOSIS (URETEROPYELOANASTOMOSIS) IN CHILDREN WITH COMPLETE URETERAL DUPLICATION

Introduction . The Duplex kidney is one of the most common anomalies of urinary system. Approaches to the surgical management of these conditions significantly differ. Taking into account the preferences of surgeons, heminephroureterectomy is offered to perform openly or laparoscopically, uretero-cysto-anastomosis of ectopic ureter or two ureters en bloc. Some publications about the possibility of ureteroureteral anastomosis have lately begun to appear. We present the experience of ureteroureteral anastomosis performed openly and laparoscopically in 9 clinics of Russia and Belarus. Objective . Improvement of treatment results of ureterohydronephrosis in children with complete ureteral duplication. Material and methods . We retrospectively reviewed medical records of 38 children who underwent ureteroureteral anastomosis surgery from 2007 to 2016. There were 10 boys (26.3%) and 28 girls (73.7%). The mean age of patients was 40.2 months. Right duplex kidney was confirmed in 15 (39.5%) children, the left one was diagnosed in 23 (60.5%) children. All the patients were divided into two groups according to the surgical technique used. Fourteen children 14 (36.8%) were included in the first group, in whom the ureteroureteral anastomosis has been performed openly, the second group comprised 24 (63.2%) patients with laparoscopically made anastomosis. Results . There weren’t any cases of conversion in this cohort. One patient in each group suffered from acute pyelonephritis. In the early postoperative period, urine leakage along the drainage occurred in 3 (12.5%) patients after laparoscopically performed ureteroureteral anastomosis, one (4.2%) child had residual ureteral stump. Thus, five (13.2%) children had complications, one (2.6%) patient required redo surgery. Conclusion . There are few clinics where ureteroureteral anastomosis is performed via open or laparoscopic approach. This operation is at the stage of development and accumulation of experience. It is a safe technique which allows to minimize the risk of loss of duplex kidney function.

Improvement of neurovascular function and cognitive impairment after STA-MCA anastomosis

ObjectiveIn patients with severe steno-occlusive disease of a main cerebral artery, decreased cerebrovascular reserve (CVR) and cognitive impairment without causative focal lesions on magnetic resonance imaging have been reported. We examined ipsilateral and contralateral CVR and cognition before and after superficial temporal artery–middle cerebral artery (MCA) anastomosis operation in patients with internal carotid artery (ICA) or MCA occlusion. MethodsIn 30 patients with ICA or MCA occlusion, cognitive impairment, and decreased CVR, we examined cognition, CVR, leukoaraiosis grades, and blood data. Data from 15 patients who underwent anastomosis were compared to that in 15 patients who did not undergo anastomosis, and to bilateral data already reported on 65 patients with severe steno-occlusive disease. ResultsCerebral blood flow, CVR, and cognition improved after anastomosis compared to before, and compared to patients without anastomosis; improved values were maintained for 5years. CVR recovered after anastomosis, matching the linear relationship between ipsilateral and contralateral CVR seen in the 65 patients. ConclusionThe postoperative improvement in cognition and synchronized recovery on the regression line between CVR of the ipsilateral occlusion and contralateral sides may suggest that the CVR is widespread and nonselectively related to cognitive function.

Tannin-based adhesive for protection of colonic anastomosis in the open abdomen

This study was aimed to evaluate the effect of tannin acid- polyethylene glycol (TP) adhesive on the wound healing process of primary colonic anastomosis in the open abdomen (OA). Adhesion strength test, degradation and hemostatic ability of TP were investigated. In a rat model, after standard colonic anastomoses, rats were divided into three groups: OA group; OA + FG (fibrin glue) group; OA + TP group. Five days after surgery, body weight, anastomotic bursting pressure (ABP), and histology of anastomotic tissue were evaluated. Performance of adhesion strength and hemostatic ability of TP was better than that of FG. The weight of TP decreased by over 50% after 11-day incubation. All rats survived well after surgery. Compared to OA group and OA + FG group, OA + TP group showed a significant improvement in body weight, ABP and healing state. Application of TP adhesive, used as an auxiliary treatment of colonic anastomosis operation, improved the wound strength and promoted the anastomotic healing after OA.

ЦИРКУЛЯРНАЯ РЕЗЕКЦИЯ ТРАХЕИ ПО ПОВОДУ РУБЦОВОГО СТЕНОЗА

The primary interventions for trachea in the thoracic surgery units are performed for the treatment of cicatricial ste-nosis of the trachea. Circular resection of the trachea is one of the treatment procedures in this pathology. The benefit of this method as compared to the others is that the resection with tracheo-tracheal anastomosis allows a one-stage recovery of patient with this pathology.The first successful resection of the trachea was performed in the late 19th century, and since then this surgery tech-nique is constantly being improved. Several methods of suture placing in anastomosis surgery are proposed, different suture materials are used, special devices are developed to facilitate the anastomosis performing. There are several tactics depending on the presence or absence of tracheostome in the patient. Different methods are worked out to approximate the trachea ends with different diameters. Prevention of anastomosis leakage is achieved by strengthen-ing the anastomosis area to reduce the suture tension. In addition, there are studies dealing with the improvement of trachea regeneration by physiotherapy impact on the anastomosis area. Laser therapy and hyperbaric oxygenation are also put forward for use.Nevertheless, a number of items remain to be solved: indications for circular resection of the trachea are not clearly formulated, the size of trachea fragment to be resect is the subject of active discussion.

Microvascular Anastomosis of Submillimeter Vessels—A Training Model in Rats

The advent of supermicrosurgery, which allows the anastomosis and dissection of small-caliber vessels ranging from 0.5 to 0.8mm in diameter, has led to the development of new reconstructive operations. Lymphaticovenous anastomosis, fingertip replantation and perforator flap surgery all require the supermicrosurgical techniques. In this paper, a rat model is described for the training of anastomosis of submillimeter vessels. Spraque-Dawley rats with the weight of 300 to 500g were used as the training models. The gender, weight and size of the femoral vessels of 20 rats were recorded. The segment of the femoral vessel which was lying on the ventral muscle group of the hind limb and distal to the origin of the superficial inferior epigastric vessels was used for the practice of microvascular anastomosis. In this study, there were 13 male and 7 female rats. The mean weight of the 20 rats was 395.6g. The mean diameters of the femoral artery and femoral vein were 0.54mm and 0.56mm respectively. The consistent size and anatomy of the femoral vessel make it a suitable training model for microvascular anastomosis of submillimeter vessels.