Conventional Anastomosis Group Research Articles

The clinical study of urinary flow parameters after drag-and-bond anastomosis for ileal orthotopic neobladder reconstruction.

To assess the viability of this procedure in laparoscopic radical cystectomy with ileal orthotopic neobladder reconstruction, the objective of this study is to examine the relationship between urinary flow parameters of urethral drag-and-bond anastomosis in the reconstruction of the ileal orthotopic neobladder. 36 patients with bladder cancer underwent laparoscopic radical cystectomy with ileal orthotopic neobladder reconstruction at Jiangxi provincial people's hospital between June 2016 and January 2021,16 patients underwent intermittent urethral anastomosis, while 20 patients underwent neobladder-urethral drag-and-bond anastomosis. The maximum bladder capacity, residual urine output, maximum urinary flow rate, and outlet morphology of the new bladder neck were all monitored throughout postoperative follow-up regularly. There was no significant difference between the urethral drag-and-bond anastomosis group (group A) and the conventional anastomosis group (group B) at 3months and 12months after surgery, and the maximum bladder capacity (3months, 488.35 ± 51.56ml vs 481.06 ± 40.61ml, t = -0.462, P = 0.647; 12months, 496.35 ± 51.09ml vs 476.56 ± 56.33ml, t = -1.103, P = 0.278), residual urine output (3months, 44.15 ± 24.12ml vs 38.69 ± 21.82ml, t = -0.704, P = 0.486;12months, 49.65 ± 26.95ml vs 36.75 ± 21.96ml, t = -1.546, P = 0.131) and maximum urine flow rate (3months, 12.36 ± 2.63ml/s vs 13.60 ± 2.82ml/s, t = 1.361, P = 0.182;12months, 12.18 ± 3.14ml/s vs 11.13 ± 3.01ml/s, t = -1.004, P = 0.322) of the two groups were not significant (P > 0.05). The new bladder outlet morphology was not distorted in group A patients, the continuity was good, and there were fewer associated complications. There was no significant difference in postoperative urodynamic parameters between the urethral drag-and-bond anastomosis group and the conventional anastomosis group, and the postoperative new bladder outlet was in good shape, with clinical significance.

Application of Half-Transected and Self-Pulling Esophagojejunostomy in Total Laparoscopic Gastrectomy for Gastric Cancer: A Safe and Feasible Technique.

Objective This study introduces a technique for esophagojejunostomy with half transected and self-pulling (HTSP) and evaluates the safety, feasibility, and clinical results of this technique in totally laparoscopic total gastrectomy (TLTG). Materials and Methods From May 2019 to March 2021, 42 patients (HTSP group) who underwent HTSP-TLTG surgery in the Department of Abdominal Tumor Surgery of Jiangxi Cancer Hospital were included in this study. The control group consisted of 50 patients undergoing conventional TLTG surgery (conventional anastomosis group) performed by the same surgical team from March 2018 to March 2020. The clinical data of the two groups were retrospectively analyzed and compared. Results The mean operation time of the HTSP-TLTG surgery was 166.7 ± 13.1 minutes and the anastomosis time was 20.8 ± 2.0 minutes, which were significantly shorter than those of traditional TLTG (P < 0.05). There were no significant differences between the two groups in blood loss, time to first exhaust, postoperative hospital stay, and incidence of surgery-related complications. Conclusion HTSP is a safe and feasible way of endoscopic esophagojejunal anastomosis, which requires a relatively low suture technique under endoscopy, and is suitable for promotion.

Does the modified blumgart anastomosis improve the outcomes of pancreaticojejunostomy in patients with carcinoma of the papilla of vater?

Background: Recently, some studies have shown that the modified Blumgart anastomosis (m-BA) for pancreaticojejunostomy is associated with a low postoperative pancreatic fistula (POPF) rate after pancreatoduodenectomy (PD). Patients with carcinoma of the papilla of Vater are likely to have soft pancreas which is a risk factor of POPF. The aim of this study was to evaluate whether m-BA reduced the occurrence of POPF in patients with carcinoma of the papilla of Vater. Methods: Between 2006 and 2018, 49 patients with carcinoma of the papilla of Vater underwent PD at our institution. The m-BA has been used since 2016. We analyzed the short-term outcomes between the m-BA group (n=15) and the conventional anastomosis group (n=34). Grade B/C POPF was defined according to the 2016 ISGPS update. Results: There were no significant differences in patient characteristics including sex, age, BMI, and UICC stage between the two groups. The rate of POPF did not differ between the groups (53.3% vs 50.0%). However, postpancreatectomy hemorrhage (PPH) in the m-BA group was significantly lower than the conventional group (0% vs 23.5%, p=0.04). Grade C POPF rate was lower in the m-BA group (0% vs 8.8%) but not statistically significant. Conclusions: Although the rates of POPF were not dissimilar, the m-BA reduced the occurrence of PPH which is associated with more severe complications.

Comparison of Blumgart versus conventional duct-to-mucosa anastomosis for pancreaticojejunostomy after pancreaticoduodenectomy.

Backgrounds/AimsPancreatic leakage is a major cause of postoperative death and morbidity after pancreaticoduodenectomy (PD). A recent study introduced Blumgart anastomosis (BA), which minimizes severe complications after PD. This study compares BA with conventional anastomosis (CA) for pancreaticojejunostomy (PJ) after PD at a single institution.MethodsA total of 87 patients who underwent PD at our hospital between January 2003 and October 2015 were enrolled in this study. The patients were divided into two groups according to the anastomosis type. Of them, 44 patients underwent anastomosis using CA (group A, conventional duct-to-mucosa anastomosis) and 43 underwent anastomosis using BA (group B, Blumgart anastomosis).ResultsThere was a significant difference in duration of the operation between groups A and B (473.1±102.0 versus 386.4±58.5 min, p<0.001) and intraoperative transfusion (2.2±2.7 versus 0.7±1.5 units, p<0.001). There was no significant difference between groups A and B in incidence of postoperative pancreatic fistula (POPF) (43.2% versus 27.9%, p=0.137) ,postoperative hemorrhage (PPH) (13.7% versus 7.0%, p=0.209), delayed gastric emptying (DGE) (29.5% versus 9.3%, p=0.063), surgical and non-surgical complications (60.5% versus 59.1%, p=0.896), length of ICU stay (9.0±6.3 versus 7.4±7.2 days, p=0.099), or length of postoperative hospital stay (37.7±16.7 versus 41.6±15.1 days, p=0.118).ConclusionsThe results of this study suggest that BA-type PJ is not inferior to CA-type PJ in terms of postoperative complications.

A systematic analysis of controlled clinical trials using the NiTi CAR™ compression ring in colorectal anastomoses.

Anastomotic leak following colorectal surgery can be a devastating adverse event. The ideal stapling device should be capable of rapid creation of an anastomosis with serosal apposition without the persistence of a foreign body or a foreign body reaction which potentially contribute to early anastomotic dehiscence or late anastomotic stricture. A systematic review was performed examining available data on controlled randomized and non-randomized trials assessing the NiTi compression anastomosis ring-(NiTi CAR™) (NiTi Solutions, Netanyah Israel) in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) standards. A protocol for this meta-analysis has been registered on PROSPERO (CRD42016050934). The initial search yielded 45 potentially relevant articles. After screening titles and abstracts for relevance and assessment for eligibility, 39 of these articles were eventually excluded leaving 6 studies for analysis in the review. Regarding the primary outcome measure, the overall anastomotic leak rate was 2.2% (5/230) in the compression anastomosis group compared with 3% (10/335) in the conventional anastomosis group; this difference was not statistically significant (RR 0.75, 95% CI 0.25-2.24; participants=565; studies=6; I 2=0%). There were no statistically significant differences between compression and conventional anastomoses in any of the secondary outcomes. This review was unable to demonstrate any statistically significant differences in favor of the compression anastomosis technique over conventional manual or stapled mechanical anastomoses.

Changes of the colonic physiologic functions after colonic anastomosis with a degradable stent in a porcine model

A new procedure of colonic anastomosis with a degradable stent has already been proven to be simple, feasible, and safe in our porcine model. In this study, we evaluated its impact on the colonic physiologic functions. A total of 20 pigs were assigned randomly to either a stent anastomosis group (SA, n = 10) or a conventional anastomosis group (CA, n = 10). Colonic anastomosis with a degradable stent was performed in the SA group, and conventional hand-sewn anastomosis was performed in the CA group. Body weight, fecal weight, total colonic transit time, immunohistochemistry staining of interstitial cells of Cajal (ICC), plasma diamine oxidases (DAO) levels, and Western blotting analysis of occludin were evaluated before and after anastomosis. No obvious diarrhea or constipation was observed in all pigs. No significant difference in body weight between the groups was detected at any time. Yet, the fecal weight was less in the CA group compared with the SA group on postoperative day (POD) 7. No observable colonic paralysis or retention occurred. For total colonic transit time, there was no significant difference between the two groups at any time or among different time points in the same group. The integrated optical density of ICC showed no significant difference on either POD 14 or 30. The plasma DAO levels were remarkably elevated after surgery, and began to decrease since POD 3. However, there was no significant difference between both two groups in plasma DAO levels at any time either. For both groups, the expression of occludin was not significantly different from their pre-surgery level on either POD 14 or 30. According to these results, this procedure with a degradable stent was supposed to be the same as the conventional hand-sewn procedure in their impact on the colonic physiologic functions.

Colonic Anastomosis with a Doxycycline-Coated Stent: An Experimental Study in a Porcine Model

Background: Matrix metalloproteinases (MMPs) are supposed to be potential drug targets to prevent leakage after colonic anastomosis. A method of colonic anastomosis by using a stent coated with doxycycline, a MMP inhibitor, was developed and its safety and feasibility, as well as the effect of locally regulating MMPs, were evaluated by comparing with the conventional method or the method with a doxycycline-free stent. Methods: 48 pigs were assigned randomly to doxycycline-coated stent anastomosis group (DSA), doxycycline-free stent anastomosis group (SA), or conventional anastomosis group (CA). In each group, pigs were subdivided into four subgroups according to postoperative observation time (3, 7, 14, and 30 days). Healing of anastomosis and expressions of MMP-2/9 were evaluated. Results: No anastomotic leakage, stricture or necrosis was observed in the DSA group. No significant difference of bursting pressure was found between the DSA group and SA group. Relative expression of MMP-2 in the DSA group was significantly lower than in the SA group on postoperative days 3 and 7. No significant differences of hydroxyproline content, microvessel density and TGF-β₁ level were found in these groups. Conclusion: These results suggested this method was feasible and safe for colonic anastomosis with the advantage of locally inhibiting MMPs.

A reliable pancreaticojejunal anastomosis with V-Loc 180 wound closure device for soft pancreatic stump.

Although mortality rates decreased in recent years, pancreaticoduodenectomy is still associated with high morbidity rates. Pancreatic fistula is the leading cause of morbidity after pancreaticojejunal anastomosis and commonly occurs in soft pancreas. The objective of this study is to compare outcomes of conventional modified invaginated end to side pancreaticojejunostomy with a new practical method using V-Loc 'rM 180 wound closure device in soft pancreas. Between December 2011 and August 2013, a total of 90 pancreaticoduodenectomy procedures were performed in our hospital. 28 of them were defined as soft pancreas according to attending surgeon and included in this study. Patients were divided into two groups consecutively and analysed for postoperative pancreatic fistula (POPF) rate, length of stay, operation time, cost and particular duration of anastomosis. Pancreatic fistulas were classified according to International Study Group on Pancreatic Fistula (ISGPF) definition. 1 grade A and 2 grade B fistulas appeared in V-Loc group (Group 1), whereas 1 grade A, 2 grade B and 1 grade C fistulas appeared in conventional anastomosis group (Group 2). Pancreaticojejunostomy with V-Loc suture is a convenient method in soft pancreas and can be performed safely.

“Tie over ring” sutureless compression based gastrointestinal anastomotic method: experimental rat model

IntroductionGiving the ever-rising trend of pediatric minimally invasive surgery besides early neonatal surgical interventions, intestinal anastomosis turns out to be a time consuming stage due to several anatomical as well as technical difficulties. A perfect bowel anastomosis method should be easy, rapid, safe and reliable in creation of bowel continuity with minimal tissue damage. In this light, sutureless anastomotic methods have been introduced, using compression based anastomosis with biofragmentable rings or powerful magnets. Accordingly, this experimental animal model study has evaluated the result of an easy, rapid intestinal sutureless anastomotic technique via simple tying over an intraluminal ring, in comparison with conventional handsewn bowel anastomosis. MethodologyThirty Wistar–Albino male rats were enrolled and small bowel was transected via a midline laparotomy. A grooved plastic ring was inserted into the ileal lumen and both intestinal cutting ends were fixed over the ring with a simple tie in the first group. On the other hand, enteroenterostomy was performed by the conventional method of handsewn anastomosis in the second group. After 14days, rats were sacrificed to evaluate for intraperitoneal adhesion and abscess formation in addition to other evidences of anastomotic leakage. Furthermore, the anastomotic site integrity, tensile strength and healing stage were assessed microscopically. ResultsThe mean operative time and intraoperative bleeding in the tie over ring group were significantly less than those in the handsewn anastomosis group. Anastomotic stricture was more common in the conventional anastomosis group while the anastomotic tensile strength was significantly higher in the tie over ring group. Histopathological healing parameters and final healing score were almost similar in both groups but mean inflammatory cell infiltration in handsewn anastomosis was significantly higher. Conclusion“Tie over ring” is a simple method of anastomosis that is feasible, fast, safe and functionally effective for bowel reconstruction in animal models that could be reconsidered in human bowel anastomosis.

Small-Caliber Arterial Anastomosis Using a CO2 Laser

The present study was designed to determine whether the use of CO2 laser irradiation could effectively maintain long-term patency in small-caliber arteri al anastomoses less than 3 mm in diameter. A preliminary study was conducted to examine the relationship between laser energy and histologic changes. The laser output of 30 to 40 mW produced a less inflammatory response, than 50 mW did and almost normal aortic architecture one month after the exposure. Therefore, a 30 to 40 mW range, over a twenty-second period, was seen as a suitable laser energy. Arterial anastomoses using a CO2 laser were performed (12 rabbits) with a suitable laser energy. Conventional anastomoses were per formed as controls (12 rabbits). The operation times, patency rate, and histo logic changes were compared in both groups at one week and at one, three, and six months after anastomoses. The anastomotic time was shorter in the laser anastomosis group than that in the control group. The patency rate was equal in both groups. However, the conventional anastomosis group revealed slight intimal hyperplasia at six months, whereas the laser anastomosis group showed almost normal neointimal development. It was hence concluded that CO2 laser welding of the anastomosis is an acceptable alternative to conventional anastomosis.