Anastomotic Methods Research Articles

Morphological analysis of microarterial media repair after 830 nm diode laser assisted end-to-end anastomosis: Comparison with conventional manual suture.

A series of 240 diode laser assisted end-to-end microvascular anastomoses (LAMA) and conventional manual anastomoses (CMA) were performed in the left and right common carotid of Wistar rats, respectively. In comparison with the two anastomotic methods, optic and scanning electron microscopic examinations were achieved from Day 0 to Day 210, in order to clarify the mechanism of media repair after diode laser welding, especially the long-term results. In the LAMA group, the cut vessel edges were welded without obvious thermal necrosis after laser treatment. On Day 10, media repair was underlined by circular bulges corresponding to the folds of cut vessel endings brought together. Inflammatory cells were regularly scattered in the adventitia in the vicinity of the anastomotic site, and were gaining ground intensively in the media by Day 20. At this time, the parallel organization of elastic laminae disappeared while the collagen network developed. On Day 120, irregular elastic fibres aggregated in the anastomotic site. On Day 210, reconstituted elastic lamina was present. In the CMA group, on Day 20, fibrotic repair appeared between cut vessel edges, and the injury incorporated by sutures was important. The elastic laminae were not reconstituted by Day 210 in any case. This microscopic study proves that the long-term repair of diode LAMA facilitates media repair and prevents fibrotic scarring of the media.

Comparative study of radical treatment of esophageal cardiac cancer by esophagogastrostomy

Digestive tract reconstruction could be completed with 3 anastomotic methods as anti-reflux method, manual end-to-end method or instrumental method. The patients were checked 2 weeks and 1 year postoperatively. The first method achieved the best result in preventing anastomotic leakage, stenosis or reflux esophagitis.

New anastomotic gun for biofragmentable anastomotic ring in low anterior resection

The biofragmentable anastomotic ring remains difficult to use for low rectal anastomosis. The authors report their experience of clinical application of the biofragmentable ring in low anterior resection with a newly designed instrument. In this series, 31 patients underwent sphincter-preserving low anterior resections for rectal tumors from May 1993 to November 1994. With the assistance of a self-developed anastomotic instrument (biofragmentable anastomotic ring gun), biofragmentable ring anastomoses were performed following low anterior resection. There was no operative mortality. One patient had clinical evidence of anastomotic leakage. In postoperative follow-up, there was no anastomotic stenosis or incontinence. Therefore, we believe biofragmentable ring rectal anastomosis is a safe and reliable alternative to other anastomotic methods in rectal surgery.

Anastomotic Methods of Facial Nerve Repair‐How to Do It

Educational objectives: To know about nerve degeneration and regeneration and how to choose the best technique for facial nerve anastomosis.

Laparoscopic colonic and rectal resection

The technology that has permitted the rapid advance of minimal access surgery has now made it feasible to perform laparoscopically assisted colon resections safely. As the instrumentation improves, specimen removal problems are solved, surgeons' sewing skills improve, and other anastomotic methods are devised, an increasing amount of colonic surgery will be done using laparoscopy. It is clear that the techniques now in use are evolving, and will be substantially different a few years hence. Previously accepted surgical principles may continue to be challenged by new techniques, which must be evaluated under strict protocol before being widely accepted. These operations should be performed by surgeons who are able to achieve the same level of radical operation that they would achieve through a laparotomy. Special training in advanced laparoscopic techniques including microsurgical suturing is a distinct advantage in performing these operations successfully. It may be best for surgeons to start with palliative procedures or operations for benign diseases of the colon, to avoid the risk of jeopardizing an operation for cancer.

PTFE, collars, and patches.

The results of PTFE grafts to crural vessels have been sufficiently poor for some surgeons to consider primary amputation for critical ischemia in the absence of suitable lengths of autologous vein from arm or leg. However, the results of two anastomotic techniques using a short segment of interposed vein, are encouraging. We have attained 1-year patency rates of 74% (n = 72) using PTFE with the Taylor patch technique (personal communication) and 47% (n = 27) using PTFE with Miller collar anastomoses to distal crural vessels. To investigate the hemodynamic benefit of these techniques, they have been tested (using a pulsatile flow model incorporating standard pressure, viscosity, graft and vessel length, and anastomotic angle) against a standard end-to-side PTFE anastomosis to cadaver internal mammary artery. There was no significant difference in flow between the anastomotic methods. Downstream resistance was dictated by the diameter of the recipient vessel providing a vein interposition technique was used (r greater than .80), but this relationship was lost if a direct PTFE-arterial anastomosis was performed (r = .06), suggesting additional anastomotic resistance in the latter. This constitutes experimental evidence to suggest that direct PTFE-arterial anastomosis risks hemodynamically important technical errors, which are avoidable by the use of either the Miller collar or Taylor patch.