Non-reinforced Group Research Articles

Effect of Fiber Reinforcement on the Flexural Strength of Long-Span, 3D-Printed, Interim Fixed Dental Prosthesis.

To inspect the impact of polyethylene fiber (Ribbond) on the long-span, 3D-printed, interim fixed dental prosthesis regarding fracture strength. A stainless steel platform was fabricated to replicate the partial edentulism for a maxillary four-unit fixed dental prosthesis. The prosthesis was fabricated by a Formlabs SLA 3D printer. The specimens were allocated into four groups of 20 each: experimental reinforced Group A (prosthesis with a slot reinforced with fiber); experimental Group B (prosthesis with a slot filled with 3D-printed material), negative control Group C (prosthesis with a slot); and control Group D (full-contour prosthesis). Fracture strength exams were performed with a universal tester. The fracture patterns were examined. A statistical analysis was conducted using one-way ANOVA and Tukey HSD test. The control group exhibited a significantly higher mean flexural load (D: 306.32 ± 50.76 N) compared to the other groups (A: 194.37 ± 68.02 N; B: 178.25 ± 42.67 N; and C: 156.68 ± 29.73 N; [P < .001]). No differences were identified among Groups A, B, and C. The fracture pattern differed between the nonreinforced Groups B, C, and D and reinforced Group A, with catastrophic failure observed in the nonreinforced group and unseparated failure observed in the reinforced group. The study findings demonstrate that the incorporation of Ribbond in 3D-printed, interim fixed dental prostheses does not significantly enhance their fracture strength. However, it does lead to a noticeable change in the fracture behavior, shifting from a complete failure to an incomplete fracture pattern.

Comparative assessment of load-bearing capacities in bolted laminated bamboo lumber connections: A study on diverse reinforcement techniques

Laminated bamboo lumber (LBL), a renowned engineered bamboo composite known for its outstanding performance and sustainability, is extensively used in modern bamboo structured buildings. This study focuses on examining the effects of diverse reinforcement techniques, particularly self-tapping screws and tension control bolts, on the load-bearing capacity of bolted LBL connections with steel plates. In total, 24 specimens were categorized into 8 groups and subjected to monotonic loading tests. The test results demonstrate that the non-reinforced group clearly shows longitudinal splitting failure at the bolt position, followed by a decrease in load-bearing capacity after failure. In contrast, the group with self-tapping screws (ST) and tension control bolts (BT) exhibited fiber tearing at the lower part of the midspan, accompanied by section bending and damage. The final load-bearing capacity of the groups reinforced with single-row three-bolt self-tapping screws and tension control bolts showed an increase of 67.30 % and 52.95 %, respectively. Likewise, the groups with single-row four-bolt configurations also demonstrated significant reinforcement effects, with increases of 40.52 % and 29.66 %, respectively. Furthermore, DIC-3D analysis was employed to examine the displacement of the connection bolts, and the van der Put model was utilized to estimate the load-bearing capacity of bolted LBL connections under splitting conditions. Subsequently, finite element models were established and calibrated based on the experimental data. The results confirm that self-tapping screws and tension control bolts can serve as structural enhancements in the design of bolted LBL connections, providing effective reinforcement for existing engineering structures.

Reinforcement in Laparoscopic Sleeve Gastrectomy: Is It Effective?

Despite the success of bariatric surgery in treating obesity, it can still lead to complications. The most serious and feared technical complications are bleeding and leakage from the gastric staple line. In this study, stapler line reinforcement was investigated to determine whether it affects postoperative leakage and bleeding rates and their management. Overall, 510 patients who underwent sleeve gastrectomy were evaluated retrospectively. They were divided into 2 groups according to whether reinforcement of the staple line with running imbricating sutures was performed. In the reinforcement group, there were two leaks (0.7%), which were diagnosed seven and eight days after surgery. In the non-reinforcement group, there were nine leaks (4%). There was no difference between the two groups in staple line bleeding. This study shows that reinforcement with continuous imbricating sutures is associated with less stapler line leakage and a lower reoperation rate at the cost of increased operative time.

Reinforcement of pimobendan with guideline-directed medical therapy may reduce the rehospitalization rates in patients with heart failure: retrospective cohort study

BackgroundPimobendan reportedly improves the subjective symptoms of heart failure. However, evidence of improved prognosis is lacking. This study aimed to determine whether reinforcing guideline-directed medical therapy (GDMT) improved rehospitalization rates for worsening heart failure in patients administered pimobendan.MethodsA total of 175 patients with heart failure who were urgently admitted to our hospital for worsening heart failure and who received pimobendan between January 2015 and February 2022 were included. Of the 175 patients, 44 were excluded because of in-hospital death at the time of pimobendan induction. The remaining 131 patients were divided into two groups, the reduced ejection fraction (rEF) (n = 93) and non-rEF (n = 38) groups, and further divided into the GDMT-reinforced and non-reinforced groups.ResultsIn patients with rEF, the rate of rehospitalization for heart failure was significantly lower in the GDMT-reinforced group than in the non-reinforced group (log-rank test, P = .04). However, the same trend was not observed in the non-rEF group.ConclusionsReinforcing GDMT may reduce the heart failure rehospitalization rate in patients with pimobendan administration and rEF. However, multicenter collaborative research is needed.Trial registrationIRB Approval by the Nippon Medical School Hospital Ethics Committee B-2021-433 (April 10, 2023).

Efficacy of Core Strength Exercises in Enhancing Rebound Jump Performance in Martial Arts Athletes

Background and Aim: Core strength exercises have become a focus in sports performance and injury prevention research. The core muscles, which include the diaphragm, abdominal muscles, and pelvic floor muscles, are instrumental in providing stability and power during athletic activities. The study focuses on the impact of core strength exercises on specific performance metrics—namely, the standing long jump and rebound jump—in martial arts athletes. Materials and Methods: The study employs a structured, eight-week intervention program to investigate the effects of core exercises on martial arts athletic performance. The study involves forty student-athletes from Guangzhou Sport University, divided into an Experimental Group (EG) and a Control Group (CG). Various physical tests are conducted both pre- and post-intervention to measure the effects. Statistical analyses, including Two-way ANOVA, are used to interpret the data. Result： For the standing long jump, the Two-way ANOVA showed no significant effect of training (F=1.129, p=0.291) or time point (F=0.587, p=0.446). Effect sizes, measured by Cohen's d, indicate a slight benefit in the core reinforcement group with a value of d=0.425, compared to d=0.111 in the non-reinforcement group. In the case of the rebound jump index, there is a pronounced effect from the group (F=4.92, p=0.03) and the time point (F=105.97, p&lt;0.001). Large effect sizes were observed, with d=2.5522 for the core reinforcement group and d=2.0457 for the no core reinforcement group. Conclusion: For standing Long Jump: Given the absence of a significant impact of core reinforcement on this metric, coaches, and athletes might consider incorporating other methodologies, such as plyometrics or attentional focus strategies, into their training regimen. For the rebound Jump Index: Core reinforcement exercises should be strongly considered for inclusion in warm-up routines for martial arts athletes, given the substantial effect size observed.

SP6.1.8 The Impact of Drain and Reinforcement on the Outcomes of Bariatric Surgery: A Prospective Study

Abstract Purpose Aimed to investigate the impact of reinforcement and abdominal drains on the outcome of laparoscopic sleeve gastrectomy (LSG). Methods A prospective study included obese patients scheduled for LSG. Patients were assigned to receive drain, reinforcement, or both according to surgeon's preference and followed up for one month after surgery. Primary outcome was identification of the association between intraoperative drain/reinforcement and incidence of postoperative complications. Results 125 (20.3%) patients received intraoperative drains. The proportion of postoperative morbidity was comparable between the drain and non-drain groups (3.2% versus 1.6%; p = 0.25). Drain group had similar incidence of blood transfusion (2.4% versus 1.7% in non-drain group; p = 0.43) and postoperative leakage (0.8% versus 0.2% in non-drain group; p = 0.36). Incidences of blood transfusion (p = 0.56) and reoperation (p = 0.98) were comparable between the drain and non-drain groups. There were no statistically significant differences between the drain and non-drain groups regarding postoperative mortality and wound infection (p &amp;gt; 0.05). In contrast, 440 (71.3%) patients received reinforcement. The proportion of postoperative morbidity was comparable between reinforcement and non-reinforcement groups (1.6% versus 2.8%, p = 0.07). Patients in reinforcement group were less likely to develop postoperative bleeding (0.7% versus 4% in the non-reinforcement group; p = 0.004), while no significant difference was detected in terms of postoperative leakage (p = 0.33) and in-hospital mortality. Conclusion Abdominal drainage did not reduce the complications of LSG patients. Reinforcement has role in controlling the bleeding but not leaks. Both techniques did not significantly impact the mortality rate.

Effect of duodenal stump reinforcement on postoperative complications in patients undergoing laparoscopic radical gastrectomy

Objective: To evaluate the influence of duodenal stump reinforcing on the short-term complications after laparoscopic radical gastrectomy. Methods: A retrospective cohort study with propensity score matching (PSM) was conducted. Clinical data of 1204 patients with gastric cancer who underwent laparoscopic radical gastrectomy at the First Affiliated Hospital of Army Medical University from April 2009 to December 2018 were collected. The digestive tract reconstruction methods included Billroth II anastomosis, Roux-en-Y anastomosis and un-cut-Roux- en-Y anastomosis. A linear stapler was used to transected the stomach and the duodenum. Among 1204 patients, 838 were males and 366 were females with mean age of (57.0±16.0) years. Duodenal stump was reinforced in 792 cases (reinforcement group) and unreinforced in 412 cases (non-reinforcement group). There were significant differences in resection range and anastomotic methods between the two groups (both P<0.001). The two groups were matched by propensity score according to the ratio of 1∶1, and the reinforcement group was further divided into purse string group and non-purse string group. The primary outcome was short-term postoperative complications (within one month after operation). Complications with Clavien-Dindo grade ≥ III a were defined as severe complications, and the morbidity of complication between the reinforcement group and the non-reinforcement group, as well as between the purse string group and the non-purse string group was compared. Results: After PSM, 411 pairs were included in the reinforcement group and the non-reinforcement group, and there were no significant differences in baseline data between the two groups (all P>0.05). No perioperative death occurred in any patient.The short-term morbidity of postoperative complication was 7.4% (61/822), including 14 cases of anastomotic leakage (23.0%), 11 cases of abdominal hemorrhage (18.0%), 8 cases of duodenal stump leakage (13.1%), 2 cases of incision dehiscence (3.3%), 6 cases of incision infection (9.8%) and 20 cases of abdominal infection (32.8%). Short-term postoperative complications were found in 25 patients (6.1%) and 36 patients (8.8%) in the reinforcement group and the non-reinforcement group, respectively, without significant difference (χ2=2.142, P=0.143). Nineteen patients (2.3%) developed short-term severe complications (Clavien-Dindo grade ≥IIIa), while no significant difference in severe complications was found between the two groups (1.7% vs. 2.9%, χ2=1.347, P=0.246). Sub-group analysis showed that the morbidity of short-term postoperative complication of the purse string group was 2.6% (9/345), which was lower than 24.2% (16/66) of the non-purse string group (χ2=45.388, P<0.001). Conclusion: Conventional reinforcement of duodenal stump does not significantly reduce the incidence of duodenal stump leakage, so it is necessary to choose whether to reinforce the duodenal stump individually, and purse string suture should be the first choice when decided to reinforce.

Prosthesis and implant survival in immediately loaded full arch restorations using fiber-reinforced versus non-reinforced temporary frameworks: a randomized clinical trial

Objective: To evaluate and compare prosthesis and implant survival in case of interim fixed complete denturesreinforced with fiber resin frameworks versus those that were not reinforced with any framework in case ofimmediately loaded full arch restorations in completely edentulous patients. Material and Methods: Thirtycompletely edentulous patients were randomly allocated into two parallel arm groups. Non-reinforced controlgroup in which patients received non-reinforced all-on-four immediately loaded fixed complete denture andFiber reinforced group in which patients received all-on-four fixed complete denture supported with glass-fiberreinforced resin framework. Prosthesis and implant survival were clinically evaluated after 4 months follow upperiod. Results: A statistically significant difference for prosthesis (p=0.032) and implant survival (p= 0.031)was found between both groups. The fiber-reinforced group showed 100% prosthesis survival and 95% implantsurvival. On the other hand, the non-reinforced group showed 73.3% prosthesis survival and 81.1% implantsurvival. Conclusion: Based on the findings of this study, it can be concluded that strengthening the fixed fullarch restorations with fiber reinforced frameworks can help overcoming the problem of interim prosthesis fractureduring the osseointegration period when used for immediate loading in completely edentulous patients. It canalso improve the survival of the immediately loaded implants.KEYWORDSDental implants; Dental prosthesis; Implant-supported; Prosthesis survival.

The Impact of Drain and Reinforcement on the Outcomes of Bariatric Surgery: A Prospective Study.

PurposeWe aimed to investigate the impact of reinforcement and abdominal drains on the outcome of laparoscopic sleeve gastrectomy (LSG).MethodsThe present study was a prospective study that included obese patients scheduled to undergo LSG. Patients were assigned to receive drain, reinforcement, or both according to the surgeon's preference and followed up for one month after surgery. The present study's primary outcome was the identification of the association between intraoperative drain/reinforcement and the incidence of postoperative complications.ResultsA total of 125 (20.3%) patients received intraoperative drains. The proportion of postoperative morbidity was comparable between the drain and non-drain groups (3.2% versus 1.6%; p = 0.25). Patients in the drain group had similar incidence of blood transfusion (2.4% versus 1.7% in non-drain group; p = 0.43) and postoperative leakage (0.8% versus 0.2% in non-drain group; p = 0.36). The incidences of blood transfusion (p = 0.56) and reoperation (p = 0.98) were comparable between the drain and non-drain groups. There were no statistically significant differences between the drain and non-drain groups regarding postoperative mortality and wound infection (p > 0.05). On the other hand, 440 (71.3%) patients received reinforcement. The proportion of postoperative morbidity was comparable between the reinforcement and non-reinforcement groups (1.6% versus 2.8%, p = 0.07). Patients in the reinforcement group were less likely to develop postoperative bleeding (0.7% versus 4% in the non-reinforcement group; p = 0.004), while no significant difference was detected in terms of postoperative leakage (p = 0.33) and in-hospital mortality.ConclusionIn conclusion, abdominal drainage did not reduce the complications of LSG patients. Reinforcement has some role in controlling the bleeding but not leaks. Both techniques did not significantly impact the mortality rate. In the future, additional, large randomized trials are needed to examine the gastrointestinal-related quality of life.

School physical education-based reinforced program through moderate-to-vigorous physical activity improves and maintains schoolchildren's cardiorespiratory fitness: A cluster-randomized controlled trial

Summary Objective The main aim was to examine the effects of a physical education-based reinforced program through outdoor physical activities and body expression on cardiorespiratory fitness in secondary students. A secondary aim was to analyze the physical activity levels during the physical education-based development and reinforced programs. Methods A sample of 92 secondary students (Mage 12.4 ± 0.7 years), from five classes, were cluster-randomly assigned into 3 groups: an experimental group without a reinforced program of physical activities [non-reinforced group (NRG)], an experimental group with a reinforced program [reinforced group (RG)], and a control group (CG). The NRG and RG students performed a physical fitness development program twice a week for nine weeks. Then, the RG completed a reinforced program through outdoor physical activities and body expression twice a week for six weeks. Students’ cardiorespiratory fitness was measured at the beginning and at the end of the development program, as well as at the end of the reinforced program. Physical activity levels were measured objectively through a heart rate monitor and subjectively by a self-reported scale during physical education sessions. Results The results of the mixed two-way [3 × 3; group (NRG, RG, CG) × time (pre-intervention, post-intervention and post-maintenance)] analysis of covariance [performance (s): F = 11.926, P Conclusion A reinforced program of nine weeks (initial development) and six weeks (maintenance thorough other physical education contents) allowed teachers to increase and maintain students’ cardiorespiratory fitness levels and to develop other curricular contents at the same time.

The mechanical behavior of thermally enhanced polypropylene concrete

This article presents the investigation of the change of mechanical properties of reinforced and non-reinforced beams produced by using a constant amount of polypropylene (PP) instead of 50% of fine aggregates by volume as a result of exposure to high temperatures (170° C) for different periods (1, 3, and 5 h) of time. The thermal enhancement procedure is applied after the 28 days of curing period. Bending, shear and torsion tests were applied to the beams. In this study, torsional moment capacity, flexural, and shear strengths were evaluated according to the American Concrete Institute (ACI318-19) and Eurocode-2 standards. These theoretical values are compared with experimental results. The polypropylene aggregate, which is used instead of fine aggregates in reinforced or non-reinforced groups, caused a decrease in flexural and shear strength compared to the control samples. The ductile fracture tendency was increased with the exposure time of PP containing samples to high temperatures. The ultimate torsional moment and critical torsional moment are reduced except for the samples that have been heat-treated for 3 h in groups with and without reinforcement. The results show that none of the existing formulas according to the relevant standards is adequate for prediction of torsional moment, flexural and shear strengths of the beams with PP concrete.

Prospective interventional study of staple line reinforcement and buttressing in laparoscopic sleeve gastrectomy

Background: Laparoscopic sleeve gastrectomy has gained increasing acceptance among bariatric surgeons and patients. The three main options for staple line reinforcement are over-sewing and buttressing with synthetic polymers or biologic tissue. The purpose of this study was to prospectively analyse the relative efficacy of gastric staple line reinforcement (SLR) by using over sewing as the method of reinforcement and comparing it with non-reinforcement laparoscopic sleeve gastrectomy (LSG) in 60 patients who were admitted in IGGMC Nagpur from May 2017 to November 2019.Methods: Obese patients with age 18-65 years, BMI 40 and above with-out co-morbidities and 35 and above with co-morbidities, and BMI below 60, with no malignancy, no hiatus hernia, no previous bariatric procedure were included. All patients underwent LSG after thorough evaluation. 30 patients had reinforced staple line, while 30 had simple staple line.Results: Total 60 patients were studied, 30 in each group. Intraoperative leak was seen in 1 patient each in both study groups. No bleeding was seen in reinforced LSG, while 3 patients had intraop bleeding in simple staple line group. 1 patient each of non-reinforced group had postop leak, postop bleeding and post op morbidity and mortality in 1 patient, while no postop leak or bleeding, morbidity or morality was seen in reinforced group.Conclusions:Reinforcement of staple line by over sewing in LSG resulted in significantly fewer surgical complications, lesser morbidity and no mortality compared to simple stapling of the gastric tube.

Staple line reinforcement during laparoscopic sleeve gastrectomy: pros and cons

Background: Nowadays, laparoscopic sleeve gastrectomy (LSG) is the most common performed bariatric procedure. Staple line reinforcement (SLR) advised for reducing gastric leaks and bleeding after LSG. The aim of this study is to evaluate the efficacy of SLR in reducing the postoperative complications compared to non-SLR during LSG.Method: Sixty morbid obese patients were scheduled for LSG in this prospective randomized study at Sohag University Hospital in the period between March 2016 to February 2018. Patients were divided randomly into two groups: Group I included 30 patients underwent LSG with over sewing of the staple line with running suture using VLoc™ V 3/0 suture. Group II underwent LSG without SLR (n=30).Results: No cases with leaks or stenosis were detected in our series. The operative time was significantly longer in the SLR group compared to the non-SLR group (125 (110-160) vs 100 (90-125) minutes respectively, p&lt;0.01). Staple line bleeding was detected postoperatively only in one case in group II (3.3%) which was treated conservatively. The length of hospital stay was longer in the non-reinforcement group but not significantly different (p=0.25).Conclusions: Staple line reinforcement during LSG has no superiority on the outcome of this operation, used by surgeons as a personal preference and as a security shield rather than for its advantages.

The utility of the Stapler with PGA sheet for pulmonary wedge resection: a propensity score-matched analysis.

Air leakage is a common complication after pulmonary wedge resection. The aim of this study was to evaluate the effect of staple line reinforcement in reducing air leakage after pulmonary wedge resection. A retrospective analysis was performed on patients who underwent pulmonary wedge resection. The patients were classified into 2 groups; the Stapler with polyglycolic acid sheet was used for the reinforced and the Stapler without polyglycolic acid sheet was used for the non-reinforced group. The patients were matched one-to-one based on a propensity score that comprised several patient characteristics. A propensity score-matched analysis was performed to compare patient outcomes. A total of 291 patients who met the inclusion criteria were investigated. There were 165 in the reinforced group and 126 patients in the non-reinforced group. Propensity score analysis generated 104 matched pairs of patients in both the reinforced and the non-reinforced groups. The rate of non-placement of chest tube was significantly higher in the reinforced group than in the non-reinforced group (61.5% vs. 36.5%; P<0.001). The rate of postoperative air leakage was higher in the non-reinforced group than in the reinforced group (13.5% vs. 1.9%, P<0.001). On logistic regression analysis, not using the reinforcement device was one of the independent factors related to pulmonary air leakage after pulmonary wedge resection (OR: 8.58, P<0.001). The use of the Stapler with polyglycolic acid sheet during pulmonary wedge resection increased the rate of intraoperative chest tube removal and reduced the rate of postoperative air leakage.

Duodenal stump reinforcement might reduce both incidence and severity of duodenal stump leakage after laparoscopic gastrectomy with Roux-en-Y reconstruction for gastric cancer.

Although duodenal stump leakage (DSL) is a relatively rare complication after gastrectomy with Roux-en-Y (R-Y) reconstruction, it is difficult to treat and can be fatal. We investigated the impact of duodenal stump reinforcement on DSL after laparoscopic gastrectomy with R-Y reconstruction for gastric cancer. This retrospective study of 965 patients with gastric cancer who underwent laparoscopic distal or total gastrectomy (LDG or LTG) with R-Y reconstruction compared surgical outcomes between two groups, the duodenal stump reinforcement group (reinforcement group) (n = 895) and that without duodenal stump reinforcement (non-reinforcement group) (n = 70). Mean operative duration was significantly longer in the reinforcement than in the non-reinforcement group (LDG; 291min versus 258min, p < 0.001, LTG; 325min versus 285min, p < 0.001). DSL occurred less frequently in the reinforcement than in the non-reinforcement group (0.67% vs. 5.71%, p < 0.001). Furthermore, non-reinforcement was an independent risk factor for DSL in multiple logistic regression analysis with adjustment for potential confounding factors. Patients with DSL in the non-reinforcement group all required re-operation, while all but one patient with DSL in the reinforcement group recovered with conservative management. Duodenal stump reinforcement in laparoscopic gastrectomy with R-Y reconstruction may reduce the risk of DSL development and minimize its severity.

Simulating the ideal geometrical and biomechanical parameters of the pulmonary autograft to prevent failure in the Ross operation.

Reinforcements for the pulmonary autograft (PA) in the Ross operation have been introduced to avoid the drawback of conduit expansion and failure. With the aid of an in silico simulation, the biomechanical boundaries applied to a healthy PA during the operation were studied to tailor the best implant technique to prevent reoperation. Follow-up echocardiograms of 66 Ross procedures were reviewed. Changes in the dimensions and geometry of reinforced and non-reinforced PAs were evaluated. Miniroot and subcoronary implantation techniques were used in this series. Mechanical stress tests were performed on 36 human pulmonary and aortic roots explanted from donor hearts. Finite element analysis was applied to obtain high-fidelity simulation under static and dynamic conditions of the biomechanical properties and applied stresses on the PA root and leaflet and the similar components of the native aorta. The non-reinforced group showed increases in the percentages of the mean diameter that were significantly higher than those in the reinforced group at the level of the Valsalva sinuses (3.9%) and the annulus (12.1%). The mechanical simulation confirmed geometrical and dimensional changes detected by clinical imaging and demonstrated the non-linear biomechanical behaviour of the PA anastomosed to the aorta, a stiffer behaviour of the aortic root in relation to the PA and similar qualitative and quantitative behaviours of leaflets of the 2 tissues. The annulus was the most significant constraint to dilation and affected the distribution of stress and strain within the entire complex, with particular strain on the sutured regions. The PA was able to evenly absorb mechanical stresses but was less adaptable to circumferential stresses, potentially explaining its known dilatation tendency over time. The absence of reinforcement leads to a more marked increase in the diameter of the PA. Preservation of the native geometry of the PA root is crucial; the miniroot technique with external reinforcement is the most suitable strategy in this context.

Outcome of over-sewing reinforcement of gastric staple line during laparoscopic sleeve gastrectomy in morbid obese patients: single center experience

Background: During laparoscopic sleeve gastrectomy (LSG), different staple line reinforcement techniques are adopted by many bariatric surgeons, aiming at reducing the incidence of bleeding and leakage from the staple line.Methods: Fifty patients suffering from morbid obesity with body mass index above 35kg/m2 were prepared for LSG. The patients were enrolled in a prospective, randomized controlled study comparing the effect of staple line reinforcement by suture over-sewing versus non-reinforcement. Patients were classified randomly into two groups. In group I, after gastric stapling, the staple line was reinforced by suture over-sewing using continuous extra-serosal invaginating absorbable polyglycol sutures. In group II (non-reinforcement group), staple line over clipping by 10 mm clips was used when needed.Results: Three cases (12%) in group II presented with collected hematomas and staple line bleeding necessitated laparoscopic evacuation and staple line bleeding control by suture over-sewing or additional clipping. In group I, one case (4%) of hematoma responded well to per-cutaneous drainage. There were 2 cases of leakage (8%) in group II versus no detectable cases in group I. Stenosis was detected in one case (4%) in group II while no detected cases in group I. The operative duration was 135 minutes in group II versus 110 minutes in group I.Conclusions: Reinforcement by suture over-sewing of the staple line as a step in LSG is a safe, technically easy, of low cost and can reduce the incidence of postoperative complications as bleeding and leakage although it significantly prolongs the operative time.

A Randomized Comparison Between Staple-Line Oversewing Versus No Reinforcement During Laparoscopic Vertical Sleeve Gastrectomy.

Varieties of intraoperative methods such as oversewing of staple lines or other reinforcement products are used for preventing the laparoscopic vertical sleeve gastrectomy (LSG) complications. The aim of this study is to evaluate the complication rates of the gastric stapling alone versus stapling with oversewing invagination of the staple line in the LSG. This is a single-center randomized study, Patients were randomized to two groups, 200 patients underwent LSG without reinforcement of the staple line and 200 patients underwent LSG with oversewing of the staple line. All patients were followed up for 1year. The data collected prospectively for statistical analysis included demographics, BMI, preoperative comorbidities, operative time, complications, and hospital stay. The overall mean operative age was 33.7±9.4years and mean BMI was 42.4±4.3kg/m2. Patient baseline characteristics (age, gender, weight, and BMI) and comorbidities were generally a nonsignificant different between the treatment arms. Surgical time was shorter in patients of the nonreinforced group (44.3±vs 51.3±4.3min; p<0.01) with lower %EWL (73±13.8 vs 80.7±13.6%, p<0.01). One patient in the nonreinforced group was complicated by gastric leak. The staple-line bleeding rate was significantly lower in patients underwent oversewing of the staple line during LSG (p<0.05). Oversewing of the staple line during LSG is a nonexpansive and easy method to decrease the incidence and severity of the postoperative bleeding. However, it is time-consuming and should be performed by experienced surgeons to avoid the complications which may occur secondary to the seroserotomy suturing.

Reinforcement of the Flexor Tendon Repair Using Human Amniotic Membrane

Human amniotic membrane is used to prevent peritendinous adhesions after tendon injuries. This study compares the mechanical properties of modified Kessler repairs and modified Kessler repairs strengthened using multiple layers of human amniotic membrane. Twenty flexor digitorum profundus tendons of sheep forelimbs were sutured by the two-strand modified Kessler technique (group A) and by the two-strand modified Kessler repair reinforced with multiple layers of human amniotic membrane (group B). To assess the mechanical performance of the repairs, tendons were subjected to a linear noncyclic load-to-failure test using a material testing machine. Outcome measures included ultimate forces and the mode of failure. The mean ± SD value of the failure strength was 34.6 ± 1.64 N for group A and 50.6 ± 5.60 N for group B. The reinforced repair provided a significantly higher ultimate load compared with the nonreinforced group (P < .001). All of the specimens failed due to suture breakage at the repair site. The results of this study show that the modified Kessler repair can be reinforced effectively with human amniotic membrane.

A Systematic Review of Staple-Line Reinforcement in Laparoscopic Sleeve Gastrectomy

Laparoscopic sleeve gastrectomy is gaining popularity as a bariatric procedure, with outcomes similar to gastric band and gastric bypass. Staple-line disruption is a significant source of morbidity and death. We aim to evaluate the effect of staple-line reinforcement on the gastric leak rate, morbidity, and mortality rate. A systematic review was performed using title key words "sleeve gastrectomy," and articles were reviewed for description of operative technique and postoperative outcomes including staple-line leak. Rates of leak, bleeding, surgical-site infection, reintervention, readmission, and mortality were analyzed. We calculated pooled event rates and 95% confidence intervals using fixed-effects modeling to determine differences between the reinforcement group (group A) and non-reinforcement group (group B). We identified 390 articles, and 30 met the inclusion criteria. Group A had 3293 patients, and group B had 1588 patients. After heterogeneity calculations, 9 variables met the criteria to be analyzed. The leak rate was 3.9% (95% confidence interval, 2.9%-5.5%) in group A and 3.2% (95% confidence interval, 2.8%-4.1%) in group B. The mortality rate was 0.8% (95% confidence interval, 0.4%-1.5%) in group A and 0.7% (95% confidence interval, 0.4%-1.1%) in group B. Our results also showed no statistical difference for any of our other 7 outcome variables. Our study shows a lack of statistical difference in leak rate, overall morbidity, or mortality rate in laparoscopic sleeve gastrectomy with or without staple-line reinforcement. Because of study limitations, we propose that prospective trials are needed to determine the effect of staple-line reinforcement on leak rates.